Comparison of the efficacy of combined treatment of micro needling and topical bleomycin and cryotherapy for the treatment of hand and foot refractory warts

Abstract

Several studies have investigated the effectiveness of bleomycin treatment for warts using multiple injection methods, including intralesional injection, multiple puncture technique, jet injection, and moonlet needle prick method, in different concentrations and doses; However, acute pain and bleeding are associated with injection methods. This study aims to compare efficacy of combined treatment of micro needling and topical bleomycin and cryotherapy for the treatment of hand and foot refractory warts. Materials and Methods: In this randomized clinical trial that was conducted in Sina Hospital in Tabriz, 90 patients with treatment-resistant warts on the hands and feet were included in the study. Treatment measures were performed every two weeks 4 times in treatment-resistant patients who did not respond to treatment after four cryotherapy sessions or whose lesions were stable for 6 months. Each wart lesion was randomly divided into a treatment group with topical bleomycin and a micro-needling or cryotherapy group. The effectiveness of the treatment in weeks 2, 4, 6, and 8 with PGA and PaGA, the amount of clearance, and side effects were evaluated in each session and the 8th week. Pain during treatment was evaluated with a visual analog scale (VAS) between 0 and 10. Results: The mean age of the patients was 33.65 ± 12.24 years and 63.3% of them were female. A total number of 186 resistant wart lesions were subjected to intervention, of which 98 cases (52.7%) were located in the plantar region and 88 cases (47.3%) were located in the plantar region. In palm lesions, the clearing rate in the bleomycin micro-needling group was significantly higher than in the cryotherapy group (86.4% vs. 61.9%; p=0.001). In foot lesions, the clearing rate was higher in the bleomycin micro-needling group than in the cryotherapy group, but no statistically significant difference was observed (69.6% vs. 54.2%; p=0.209). Significantly, in the 8th week after the intervention in the bleomycin micro-needling group, the number of lesions and the diameter of warts on the palms and feet decreased compared to the cryotherapy group. No unwanted side effects were observed after using bleomycin micro-needling; However, in patients receiving cryotherapy, local pain, blisters, and scars were seen after the intervention.