Dr. Michael Tirgan, MD - New York City

Skin Growth Removal / Skin Tumor Treatment; One Patient at a Time.

Bleomycin tattooing for Keloids and hypertrophic scars

Bleomycin is a potent anti cancer drug.  It is primarily used intravenously in treatment of Hodgkin's Disease and Testicular Cancer.  Bleomycin has been around for a few decades.  Bleomycin has also been used in treatment of keloids. 

First line medical treatment for most flat keloids is to use steroid injections.  Cryo-surgery is a reasonable option for bulky flat keloids. When keloids become resistant to steroid injections, I typically recommend injection of the keloid with 5-FU chemotherapy or bleomycin tattooing.

Dr. Espana has published his results in 13 patients.  He used a method of tattooing to inject very small amount of Bleomycin into the keloid tissue.  He reported "complete flattening of keloids in six patients, and highly significant flattening in  six other patients and significant flattening in one patient"  He reported recurrence in two patients.   Itching in all patients disappeared after one treatment.  The treatment was well tolerated without any noticeable toxicity.

Dr. Naeini has published on her results in 17 patients with keloid and 6 patients with hypertrophic scars, and reported 88% response rate to Bleomycin tattooing.

Bleomycin has been used in other non cancer indications, such as keratoacanthoma, neurofibromas and certain warts.  When used in very low doses and with tattooing procedure, bleomycin seems to be well tolerated and free of systemic effects. 

The video below depicts the method I use to perform bleomycin tattooing.

Treatments for  superficially spreading keloids

Treatment of superficially spreading keloid is quite challenging.  These keloids grow and spread over a wide area of the skin; and if they occur over the joints, they can often result in limitations of the range of motion of the joints.   These keloids are best treated with intra lesional injection of chemo therapy drugs such as bleomycin, or with steroids when there is a contraindication for usage of chemotherapy drugs. 

My approach to these keloids is to treat them with tattooing bleomycin over the keloid surface.  By tattooing, we inject very small amount of bleomycin into the keloid tissue.  Bleomycin is a very effective medicine for treatment of keloids.

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