Intralesional Methotrexate Versus Intralesional Bleomycin in Treatment of Plantar Warts

Alshaimaa B. Fayed, Resident of Dermatology and Venereology, Faculty of Medicine, Mansoura University, Egypt.Follow
Mohammed K. Selim, Professor of Dermatology, Andrology& STDs, Faculty of Medicine, Mansoura University, Egypt.
Amal Wagdy, Assistant professor of Dermatology, Andrology& STDs, Faculty of Medicine, Mansoura University, Egypt

Corresponding Author

Alshaimaa B. Fayed

Subject Area

Dermatology

Article Type

Original Study

Abstract

Background:

Plantar warts, benign proliferative cutaneous lesions of the plantar aspect of the foot brought on by a human papillomavirus (HPV) infection, are among the most prevalent conditions seen in dermatology practices across the globe. Plantar warts can be treated in a variety of ways, including systemic methods, local pharmaceutical therapies (such as salicylic acid and imiquimod), physical modalities (such as cryotherapy and laser therapy), photodynamic therapy, and surgical excision. Also, recently, intralesional injection of cytotoxic drugs e.g. bleomycin and methotrexate, has shown a promising effect on plantar warts.

Objectives: The aim was to compare the efficacy and safety of methotrexate and bleomycin in the treatment of plantar warts.

Subjects and methods: This study included 80 patients with at least one plantar wart. Every patient involved in this research has given their informed written consent. Based on common clinical manifestations, cases were diagnosed. "Patients were randomly assigned into two equal groups of 40 patients each (Group A or Group B) using a computerized random number generator with a single-blinded design. Accordingly, intralesional methotrexate was administered to each wart in Group A, while bleomycin was administered to those in Group B. Injections in both groups were repeated until complete clearance or for a maximum of four sessions. Based on previously reported treatment protocols, the injections were repeated every 2 weeks in Group A (Methotrexate),whereas they were administered every 4 weeks in Group B (Bleomycin). Patients were clinically evaluated at baseline and at each treatment visit. Treatment was continued until complete clinical clearance or a maximum of four sessions. Final efficacy assessment was performed at the first follow-up visit after the last treatment session according to each treatment protocol.

Results: Regarding the percentage of improvement among studied groups, complete clearance was achieved in Group B (bleomycin) compared to 30.6% of Group A (methotrexate) (P=0.001). Patient satisfaction was significantly higher in Group B (P

Conclusion: In the context of plantar wart treatment, both intralesional bleomycin and methotrexate had a good response, but bleomycin demonstrated a superior efficacy compared to methotrexate, as it had a complete and faster response from one or two sessions than full concentrated methotrexate, which treated only a quarter of the cases. Both treatments were associated with mild and transient local adverse effects.

Recommended Citation

Fayed, Alshaimaa B.; Selim, Mohammed K.; and Wagdy, Amal (2026) "Intralesional Methotrexate Versus Intralesional Bleomycin in Treatment of Plantar Warts," Mansoura Medical Journal: Vol. 56 : Iss. 3 , Article 7.
Available at: https://doi.org/10.58775/2735-3990.1615