Background: Intralesional injections of vitamin D and bleomycin have gained growing clinical interest in the treatment of recalcitrant plantar warts, with pain as a major limitation associated with their use. Objective: To assess the clinical outcomes of vitamin D and bleomycin in managing treatment-resistant plantar warts. Methods: An interventional comparative study conducted on patients diagnosed with recalcitrant plantar warts over 9 months and not treated for two months. Patients were divided randomly into two groups: group A (24 patients received intralesional vitamin D) and group B (24 patients received intralesional bleomycin). The clearance rate and pain score were estimated by visual analogue scale (VAS). Results: 48 patients were enrolled in the study. Bleomycin produced a significantly greater reduction in wart size at early time points (2, 4, 6, and 8 weeks). Vitamin D also resulted in wart size reduction but with less consistency. By the 4-month follow-up, both treatment groups showed substantial clearance, with no statistically significant difference in overall outcomes. Vitamin D produced significantly lower pain scores at 1, 2, and 3 weeks, indicating better tolerability. By week 8, VAS scores between the groups converged and were no longer significantly different. Conclusions: Intralesional bleomycin and vitamin D are effective in the treatment of recalcitrant plantar warts. Bleomycin produced more rapid lesion regression, whereas vitamin D exhibited a more favorable tolerability profile.
