Bleomycin

  • Derivative of Streptomyces verticillus
  • Pregnancy Category D

  • Intra-lesional

  • Warts: 
    • 0.1-0.3ml of 1U/mL & maximum of 2 mL/ treatment, q3 -6 weeks
  • Vascular Anomalies:
    • 0.2-0.4 mg/mL q2 – 4 weeks

  • Induces DNA breakage via oxidative damage
  • Warts: effect on infected keratinocytes, not directly on HPV

Off-label:

  • Refractory plantar warts
  • Vascular tumors (hemangioma & lymphatic malformations)
  • Keloids

  • Pregnancy & lactation
  • Immuno-suppression
  • Vascular compromise

  • Very painful (most common, may help to use local/regional anesthesia), pain/burning can last 2 – 3 days
  • Nail dystrophy (if periungual injection)
  • Erythema, edema, burning; occasional blistering and tissue necrosis
  • Raynaud phenomenon
  • Ulceration of vascular anomalies
  •  If IV: anaphylaxis, flagellate hyperpigmentation

* For further reading refer to a pharmacology source

  • Wart: inject directly and try to blanch it (if too superficial: blister, leakage; too deep: no blanching); try to avoid injecting into vessel. 65-80% resolved after 1-2 injections
  • Vascular anomalies: lower concentration for children, response in 4-10 injections
  • If refrigerated, stable x 4weeks