Efficacy and tolerability of intralesional bleomycin in dermatology: A systematic review

J Am Acad Dermatol. 2020 Sep;83(3):888-903. doi: 10.1016/j.jaad.2020.02.018. Epub 2020 Feb 15.

Abstract

Bleomycin is widely used as an off-label treatment for various dermatologic indications. However, a much-needed critical appraisal of the currently available evidence is lacking. We therefore evaluated the quality of clinical evidence for the efficacy and safety of intralesional bleomycin treatment for dermatologic indications with the aim to provide evidence-based recommendations for clinical practice. The PubMed, Embase, Medline Ovid, Web of Science, Cochrane Central, and Google Scholar databases were systematically searched. Two authors independently selected relevant studies according to predefined inclusion and exclusion criteria. We assessed the methodologic quality with the Cochrane Collaboration risk-of-bias assessment tool and selected 10 randomized clinical trials and 15 clinical controlled trials. Treatment indications included common warts, nonmelanoma skin cancer, cutaneous metastases, keloid and hypertrophic scars, and hemangioma. Intralesional bleomycin treatment showed significantly higher cure rates for warts compared with other treatments. Local adverse events included erythema, blackening, eschar formation, and superficial ulceration. None of the studies reported systemic adverse events. Methodologic quality of the studies was generally low. Consequently, no firm recommendations can be made for intralesional bleomycin treatment in clinical practice. However, this review suggests that intralesional bleomycin is a successful and well-tolerated treatment for recalcitrant warts.

Keywords: bleomycin; cutaneous metastases; dermatology; drug response; efficacy; electrochemotherapy; hemangioma; hypertrophic scars; intralesional; keloid; nonmelanoma skin cancer; safety; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Bleomycin / administration & dosage*
  • Bleomycin / adverse effects
  • Cicatrix, Hypertrophic / drug therapy*
  • Erythema / chemically induced
  • Erythema / epidemiology
  • Hemangioma / drug therapy*
  • Humans
  • Injections, Intralesional / adverse effects
  • Keloid / drug therapy*
  • Randomized Controlled Trials as Topic
  • Skin Neoplasms / drug therapy*
  • Skin Pigmentation / drug effects
  • Skin Ulcer / chemically induced
  • Skin Ulcer / epidemiology
  • Treatment Outcome
  • Warts / drug therapy*

Substances

  • Bleomycin