Bleomycin (Intralesional — Keloid/Wart Treatment)

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.