الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
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.
This study aimed to compare between the efficacy of microneedling‐assisted multipuncture technique with topical bleomycin spraying and intralesional injection of bleomycin in treatment of plantar warts.
The present study included 60 Patients who were divided into four groups A, B, C and D containing 20, 20, 10 and 10 patients respectively. group A was treated by intralesional injection of bleomycin, group B was subjected to microneedling pentype with topical bleomycin spraying, group C was subjected to intralesional saline injection and group D was subjected to microneedling pentype with topical saline spraying.
All of the patients were subjected to treatment at two weeks interval with maximum of four sessions. Follow‐up visits were scheduled two months after the last session to detect recurrence.
The results of the present study revealed complete clearance in 80% and partial resolution in 5% of patients in the intralesional bleomycin group versus complete resolution 90% and partial resolution in 10% of patients in microneedling assisted topical bleomycin spraying group, this difference was statistically insignificant.
There was statistical significant increase in the number of treatment sessions needed for complete response among th