History and Objectives: Intralesional bleomycin therapy is an effective method for treatment of intractable warts. Diverse concentration of drugs by different methods and protocols are applied and various degrees of success rates have been achieved. In the present study, we have used a new technique of bleomycin injection to treat recalcitrant warts by multiple puncture technique (MPT).

Materials and Methods: Following local anesthesia with 1% lidocaine on 158 warts in 55 patients with recalcitrant common, palmar, periungual, subungual, plantar and mosaic warts. Bleomycin solution (1 mg/ml) was dropped on the surface of the wart and picked into the wart by insulin syringe (40 punctures/5 mm² surface area). The treatment was repeated on monthly basis until improvement was observed,. However treatment was repeated for maximum of four times.

Results: A success rate of 83.5% was achieved ranging from 50% in mosaic warts to 91.8% in common warts, which compares with results of other studies. This technique is easily available and well tolerated with minimal or no complication.

Conclusion: Due to success rate, availability and minimal complication and relapse, intralesional bleomycin therapy by MPT is an effective useful, safe and generally well tolerated treatment of recalcitrant warts especially periungual, palmar, subungual plantar and mosaic sites.