Plantar warts are benign epithelial tumors affecting the plantar surface of the foot. They are caused by various strains of HPV. They may cause pain and disfigurement. They mostly occur in children older than five years, adolescents and immunosuppressed patients. Treatment of plantar warts is a therapeutic challenge regarding both tolerability and efficacy.
Bleomycin is used for the treatment of severe types of warts. The bleomycins are a group of water-soluble glycopeptides extracted from a strain of Streptomyces verticillus with an anti-bacterial, antiviral and cytotoxic activity. Intralesional bleomycin has been reported to be a promising approach and effective treatment of resistant warts, with cure rates from 63% to 100%. The mechanism of action of bleomycin in the treatment of warts is not clear. Bleomycin has been observed to inhibit DNA and protein synthesis and hence can induce tissue death.
Microneedling uses fine needles to puncture the epidermis. Needling of plantar wart induces local inflammation and a subsequent cell mediated immune response against human papillomavirus. It is used also as a method of transdermal drug delivery by creation of micropores through the stratum corneum and this technique enhance the absorption of drugs like bleomycin, enhances the efficacy and decreases the period of therapy.