Intralesional Injection of Bleomycin versus 5-Fluorouracil in Treatment of Plantar Warts: Clinical and Dermoscopic Study

Background: Plantar warts are skin lesions on the Plantar surface of the foot resulting from infection of keratinocytes by human papilloma virus. Intralesional bleomycin and 5- fluorouracil (5-FU) are therapeutic options utilized to treat various dermatological conditions including planter warts. Objectives: This study aimed to compare the efficacy and safety of intralesional injection of bleomycin versus 5-FU in patients with plantar warts. Methods: Randomized comparative interventional study included 60 patients complaining of plantar warts, they were divided randomly into 2 equal groups; Bleomycin and 5-FU groups. Clinical examination, photographic and dermoscopic evaluation were done before and after treatment. Results: As regard response to treatment, in bleomycin group (63.3%) of patients showed complete clearance clinically and dermoscopically versus (76.7%) in 5-FU group, while warts disappeared clinically, but a dermoscopy revealed vestiges was about (30%) in the bleomycin group versus (16.7%) in 5-FU group without significant difference in response rate or in the patients’ satisfaction between the two groups. The most frequent side effect was pain at the injection site without significant difference between bleomycin (66.7%) and 5-FU group (70%). Regarding the follow-up after 3-months, only one case had recurrence in the bleomycin group (3.3%) versus no case in 5-FU group (0%). Conclusion: Both Intralesional injection of bleomycin and 5-FU are safe, effective and practical treatment modalities for plantar warts, with higher response rate and lower recurrence in Intralesional 5-flurouracil injection. Dermoscope is recommended in early diagnosis, preventing recurrence and tracking the clinical response to treatment.