Nail dystrophy following intralesional injections of bleomycin for a periungual wart

Endoscopic transmucosal direct puncture sclerotherapy for management of airway vascular malformations

“…35 In addition, bleomycin-induced skin toxicity may also include alopecia, pruritus, skin tenderness, nail changes, rash, blistering, striae, hyperkeratosis, and erythema. These are relatively late manifestations, usually developing after a cumulative dose of 150 to 200 mg. [36][37][38][39][40] Adverse effects localized to the hands unrelated to the injection site and skin reactions to a subcutaneous bleomycin injection site have also been described. 41,42 The collective data show that bleomycin is an effective agent with minimal postprocedure tissue swelling or inflammation.…”

Successful Treatment of Periungual Warts with Diluted Bleomycin Using Translesional Multipuncture Technique: A Pilot Prospective Study

“…Few studies have reported the clearance of untreated lesions. 2,20 Therapeutic concentrations of 1, 0.5, and 0.25 U/mL have been previously used for different types of warts. 5 Several reports have documented untoward effects such as hyperpigmentation, localized pain, and cellulitis.…”

“…1 Treatment may also disturb the nail matrix and cause permanent nail damage. 2 Intralesional bleomycin has been used for the treatment of warts since the 1970s. 3,4 It causes tissue death by inhibiting DNA and protein synthesis.…”

“…5 Bleomycin was used for the treatment of periungual warts in patients but with fear of nail loss or dystrophy. 2 Different concentrations of bleomycin have been used, with variable results. The present study is unique in its use of a minimal concentration with the aim of decreasing the incidence of adverse effects.…”

Bleomycin and the skin

“…Nail dystrophy and fingernail loss were reported following intralesional bleomycin injections for periungual warts. 91,92…”