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Cytotoxic Antibiotic — Intralesional Use (Sclerotherapy)

Bleomycin (Intralesional — Keloid/Wart Treatment)

Brand names: Bleomycin Sulfate Injection

A cytotoxic antibiotic used by intralesional injection in plastics and dermatology to treat keloid and hypertrophic scars and recalcitrant viral warts.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Bleomycin induces DNA strand breaks and inhibits cell division; in scars and warts it is thought to cause fibroblast and keratinocyte apoptosis and local tissue necrosis.

Prescribing in practice

  • It is a cytotoxic agent requiring safe-handling precautions and must be avoided in pregnancy; pulmonary toxicity is a recognised risk of systemic bleomycin and cumulative exposure should be respected even with local use.
  • Local injection commonly causes pain, hyperpigmentation and, rarely, dermal atrophy or tissue necrosis.
  • Raynaud-type vascular changes and flagellate pigmentation have been described with bleomycin exposure.

Monitoring

Monitor the lesion at follow-up for response and local adverse effects; systemic toxicity is unlikely with appropriate intralesional volumes.

Counselling the patient

  • Expect injection-site pain and possible darkening of the skin over the area.
  • Report any non-healing sore, finger colour changes or breathing problems.
  • Repeat sessions may be needed for full effect.

Evidence & guidelines

Intralesional bleomycin is an established second-line option for resistant keloids and warts in specialist dermatology and plastic-surgery practice.

Reference: Naeini et al. Dermatol Surg 2006 (bleomycin keloids); MHRA SPC Bleomycin Injection; BBA Scar Management Guidelines 2019; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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