Bleomycin to Lidocaine Ratio for Wart Treatment
No Established Ratio in Guidelines or Literature
There is no recommended bleomycin to lidocaine ratio for wart treatment because these medications are not mixed together—lidocaine is used separately for local anesthesia prior to bleomycin administration. 1, 2
Standard Bleomycin Administration Protocol
Anesthesia Administration (First Step)
- Administer 1% lidocaine as local anesthesia to the wart area before bleomycin injection 1
- Alternatively, topical EMLA cream (lidocaine and prilocaine) can be applied for local anesthesia prior to bleomycin administration 3
- The anesthetic is given separately and allowed to take effect before proceeding with bleomycin 1
Bleomycin Dosing (Second Step)
- Use bleomycin at a concentration of 0.5-1.0 mg/ml (or 0.5-1.0 IU/ml) for intralesional injection 1, 2, 4
- Inject 0.2-0.8 mg per wart depending on lesion size, with a maximum total dose of 2 mg per treatment session 4
- Administer at 2-week intervals if repeat treatments are needed 2
Important Clinical Context
Why These Are Not Mixed
- Lidocaine provides temporary anesthesia to minimize injection pain 1
- Bleomycin is the therapeutic agent that destroys wart tissue through cytotoxic effects 3, 5
- Mixing these medications would dilute the bleomycin concentration and potentially compromise efficacy 2
Treatment Efficacy
- Intralesional bleomycin achieves cure rates of 67.8-99.23% for recalcitrant warts 5, 2
- Success rates vary by location: periungual warts (94%), extremity warts (95%), plantar warts (60%) 2
- Most warts respond after one or two injections given at 2-week intervals 2
Common Pitfall to Avoid
- Do not attempt to premix bleomycin with lidocaine in the same syringe—this is not standard practice and lacks evidence for safety or efficacy 1, 2
- Always anesthetize first, then inject bleomycin separately into the anesthetized wart base 1