Treatment of Verruca Vulgaris in Both External Auditory Canals Using Bleomycin Injections

Abstract

Verruca vulgaris is caused by human papillomavirus (HPV) infections. Verruca in the external auditory canal (EAC) has rarely been reported. A previous case report introduced surgical excision as a treatment for verruca in the EAC. We present a case of verruca vulgaris in both EACs that was successfully treated with an intralesional bleomycin injection. A 32-year-old male patient presented with ear fullness and palpable lumps in both EACs. Both of his canals were filled with multiple pinkish, papillomatous masses. Verruca vulgaris was confirmed by skin biopsy. An otolaryngologist referred this patient and recommended surgical excision. However, we performed intralesional bleomycin injections for treatment. Twice intralesional bleomycin injections at one-month intervals had excellent results without recurrence, ulceration or scar formation. This result indicates that bleomycin injections may prove to be an effective first-line treatment of verruca in the EAC.

Ungual warts: comparison of treatment with intralesional bleomycin and electroporation in terms of efficacy and safety

“…Distinct techniques, doses and numbers of applications have been described with different cure rates (71–100%) . In our study, only one application was performed, with a 6‐month follow‐up.…”

“…44 Distinct techniques, doses and numbers of applications have been described with different cure rates (71-100%). [14][15][16]22,23,43,44 In our study, only one application was performed, with a 6month follow-up. This explains why the cure rate for the group using bleomycin alone (50%) was lower than the average cure rate (71-94%).…”

“…Several papers reinforce the intralesional use of bleomycin for the treatment of ungual warts resistant to previous treatments, with the technique being considered as a third-line therapeutic and recommendation degree II from the perspective of evidence-based medicine. 1,7,[11][12][13][14][15][16][17][18][19][20][21] The concentration used ranges from 1 to 5 U/mL of solution, and there is no standardized dose. The systemic absorption is considered low; however, use in children, pregnant women, patients with vascular diseases and immunodeficiency disorders should be avoided.…”

Eficácia e segurança do uso da eletroquimioterapia associada à bleomicina intralesional comparado ao uso da bleomicina intralesional, no tratamento das verrugas periungueais: ensaio clínico randomizado duplo-cego

“…Inúmeros autores relatam as mais diferentes técnicas e variações na aplicação da bleomicina no tratamento das verrugas ungueais, com diferentes taxas de cura (71 a 100%) (Shumer e O'Keefe, 1983;Bunney et al, 1984;Amer et al, 1988;Dhar et al, 2009;Soni et al, 2011;Kruter et al;Lee et al, 2015a). No presente estudo a taxa de cura com a monoterapia com bleomicina foi de 50%.…”

“…A literatura mostra que o uso da bleomicina (intralesional) é considerado primeira linha no tratamento das verrugas periungueais, com taxas de cura superiores, quando comparadas com as demais técnicas, baixo risco de distrofias ungueais e bom perfil de segurança (Sterling et al, 2001;Saitta et al, 2008, AlGhamdi e Khurram, 2011Herschthal et al, 2012;Lee et al, 2015a;Lee et al, 2015b). Apesar de pouco frequente, o fenômeno de Raynaud pode ocorrer em casos onde a aplicação é profunda e com volume excessivo (AlGhamdi e Khurram, 2011).…”