الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Warts are caused by human papillomaviruses (HPVs) which infect keratinocytes. Treatment of plantar warts is difficult and requires multiple treatments and they are more refractory to treatment than common warts and recurrence is common.
Bleomycin is derived from ‘Streptomyces verticillus’ and has antitumor, antiviral, and antibacterial activities related to its ability to bind DNA and cause strand scission. Since 1970s, numerous reports have been published on the use of intralesional bleomycin for the treatment of warts, with cure rates ranging from 14% to 99%.
In the present study, the response of plantar warts to the treatment with intralesional injection of bleomycin was evaluated both clinically and by the dermoscope. Forty six patients having plantar warts, with no history of previous treatments were divided into 2 groups; bleomycin group included 26 patients were treated with bleomycin and control group included 20 patients treated with normal saline solution. There was no statistical difference between the 2 groups regarding the ages of the patients (p= 0.9) or the duration of their warts (p= 0.1).
In the bleomycin group (26 patients), plantar warts were treated with intralesional injection of bleomycin 1 mg/ml. Treatment sessions were done every 2 weeks with a maximum of 4 sessions and the final evaluation was done 2 weeks after the last session. Complete clinical clearance of plantar warts was observed in 88.5% of the patients (23/26 patients), clinical improvement in 7.7% of them (2/26 patients) and clinical failure in only 3.8% of the patients (1/26 patients). There was no correlation between the duration of the plantar warts and their response to treatment (r= -0.1, p= 0.8).
In the control group (20 patients), plantar warts were treated with intralesional injection of normal saline solution for 4 sessions. Clinical improvement was observed in only 5% of the patients (1/20 patient). The medical response in patients who received bleomycin is statistically better than that in patients who received placebo (p< 0.0001).
In this study, treated warts were examined by the dermoscope before injection in each session and 2 weeks after the last session. Complete clinical clearance of plantar warts was reported in 88.5% of the patients (23/26 patients). However, 69.3% these patients (18/26 patients) showed complete clearance of their warts proved by dermoscopy, while the remaining 19.2% (5/26 patients) showed clinical clearance but dermoscopy revealed remnants of the warts.
from the results obtained by this study, it can be concluded that intralesional injection of bleomycin is an effective and safe treatment of plantar warts with a cure rate of 69.3% of the patients. The study also recommends the use of dermoscopy in the evaluation of treatment success, as it can accurately tell if the wart needs further treatment, preventing premature stoppage of the treatment, thus decreasing the possibility of recurrences.