Systemic treatment

Oral immunomodulators

The efficacy of cimetidine 750-1200 mg per day has never been definitively proved. The drug is expensive and not always well tolerated.

Interferon

The efficacy of interferons is still debated and the necessity of intravenous administration together with cost of treatment do not recommend its routine use. However, complete cure of recalcitrant and extensive periungual and subungual warts has been reported after interferon beta treatment.

Antimitotics

Intralesional injections of bleomycin are effective in the treatment of periungual warts. After local anaesthesia, the bleomycin solution (1 U bleomycin per 1 ml sterile saline) is dropped on the wart surface. The wart is then punctured using a disposable needle approximately 40 times per 5 mm2 area. The wart slowly undergoes necrosis with formation of an eschar that can be scraped away 3-4 weeks after treatment. Residual warts can be retreated.

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