BACKGROUND: Some warts prove resistant to multiple therapies, particularly on an immunosuppressed patient. A previous study revealed that combination therapy with pulsed dye laser and intralesional bleomycin was effective on recalcitrant warts. OBJECTIVE: The aim of this study was to confirm whether the combination therapy with pulsed dye laser and intralesional bleomycin was effective for the treatment of recalcitrant warts. METHOD: Fifteen patients, all with recalcitrant warts, were recruited. Two patients were on long-term immunosuppressant drugs. Twenty warts were treated in total. The warts were anaesthetized with local anesthetic cream (EMLA(R) 5% cream) then treated with a pulsed dye laser (5mm spot, fluence 9.5-10J/cm2). Immediately following this, bleomycin (1mg/ml) was injected into the base of the warts. At 3-4 weeks after the last treatment, the warts were evaluated to assess clearance rate, total treatment numbers and side effects. RESULT: 1. Complete clearance was achieved for 17 out of 20 warts (85%). 2. Partial clearance was achieved for 3 out of 20 warts (15%). 3. Recalcitrant warts were cleared with an average of 1.95 treatments. 4. Recalcitrant warts on the immunosuppressed patients were cleared with an average of 2.0 treatments. 5. No significant side effects were observed. CONCLUSION: Combination therapy with the pulsed dye laser and intralesional bleomycin appears to be a safe, rapid, well tolerated and successful treatment for recalcitrant warts. It also appears to be effective for recalcitrant warts on immunosuppressed patients.
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