Skip to main content
SpringerLink
Log in

Don’t despair over difficult-to-treat warts

  • Disease Management
  • Published:
Drugs & Therapy Perspectives Aims and scope Submit manuscript

Abstract

Cutaneous warts, common in children and immunocompromised patients, can be painful and socially and functionally restricting. Caused by several human papillomavirus types, they may resolve spontaneously or respond to traditional treatments. If not, pharmacological options for difficult-to-treat warts include intralesional and/or topical immunological and antiviral agents, with clearance of all warts achieved in many patients. Vaccines, Candida albicans antigen, vitamin D analogues, cidofovir, imiquimod and chemotherapeutics are worth considering.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sterling JC, Gibbs S, Haque Hussain SS, et al. British Association of Dermatologists’ guidelines for the management of cutaneous warts 2014. Br J Dermatol. 2014;171(4):696–712.

    Article  CAS  Google Scholar 

  2. Ringin SA. The effectiveness of cutaneous wart resolution with current treatment modalities. J Cutan Aesthet Surg. 2020;13(1):24–30.

    PubMed  PubMed Central  Google Scholar 

  3. Muse ME, Stiff KM, Glines KR, et al. A review of intralesional wart therapy. Dermatol Online J. 2020;26(3):1–16.

  4. Friedman PC. Management of difficult-to-treat warts: traditional and new approaches. Am J Clin Dermatol. 2021;22(3):379–94.

    Article  Google Scholar 

  5. Kwok CS, Gibbs S, Bennett C, et al. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2012;9:CD001781.

    Google Scholar 

  6. Johnson SM, Roberson PK, Horn TD. Intralesional injection of mumps or Candida skin test antigens: a novel immunotherapy for warts. Arch Dermatol. 2001;137(4):451–5.

    CAS  PubMed  Google Scholar 

  7. Khozeimeh F, Jabbari Azad F, Mahboubi OY. Intralesional immunotherapy compared to cryotherapy in the treatment of warts. Int J Dermatol. 2017;56(4):474–8.

    Article  CAS  Google Scholar 

  8. Hodeib AAE, Al-Sharkawy BG, Hegab DS, et al. A comparative study of intralesional injection of Candida albicans antigen, bleomycin and 5-fluorouracil for treatment of plane warts. J Dermatol Treat. 2019;32(6):663–8.

    Article  Google Scholar 

  9. Attwa E, Elawady R, Salah E. “Cryo-immuno-therapy” is superior to intralesional Candida antigen monotherapy in the treatment of multiple common warts. J Dermatol Treat. 2020. https://doi.org/10.1080/09546634.2020.1720585.

    Article  Google Scholar 

  10. Maronn M, Salm C, Lyon V, et al. One-year experience with candida antigen immunotherapy for warts and molluscum. Pediatr Dermatol. 2008;25:189–92.

    Article  Google Scholar 

  11. Abd El-Magiud EM, Abd El-Samea GM, Gaber HD. Intralesional injection of measles, mumps, and rubella vaccine versus cryotherapy in treatment of warts: a randomized controlled trial. Dermatol Ther. 2020;33(2):e13257.

    Article  CAS  Google Scholar 

  12. Shaheen MA, Salem SAM, Fouad DA, et al. Intralesional tuberculin (PPD) versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: a comparative clinical and immunological study. Dermatol Ther. 2015;28:194–200.

    Article  Google Scholar 

  13. Nofal A, Marei A, Ibrahim A, et al. Intralesional versus intramuscular bivalent human papillomavirus vaccine in the treatment of recalcitrant common warts. J Am Acad Dermatol. 2019;82(1):94–100.

    Article  Google Scholar 

  14. Ling YK, Chua SH, Yew YW, et al. Human papillomavirus vaccine for the treatment of recalcitrant extragenital warts. J Am Acad Dermatol. 2017;76(6):AB159.

    Google Scholar 

  15. Yang MY, Son JH, Kim GW. Quadrivalent human papilloma virus vaccine for the treatment of multiple warts: a retrospective analysis of 30 patients. J Dermatolog Treat. 2019;30(4):405–9.

    Article  CAS  Google Scholar 

  16. Bossart S, Imstepf V, Hunger RE, et al. Nonavalent human papillomavirus vaccination as a treatment for skin warts in immunosuppressed adults: a case series. Acta Dermatol Venereol. 2020;100(6):adv00078.

    Article  Google Scholar 

  17. Amirnia M, Khodaeiani E, Fouladi DF, et al. Intralesional immunotherapy with tuberculin purified protein derivative (PPD) in recalcitrant wart: a randomized, placebo-controlled, double-blind clinical trial including an extra group of candidates for cryotherapy. J Dermatol Treat. 2016;27(2):173–8.

    Article  CAS  Google Scholar 

  18. Jaisinghani A, Dey V, Suresh M, et al. Bacillus Calmette-Guerin immunotherapy for recurrent multiple warts: an open-label uncontrolled study. Indian J Dermatol. 2019;64(2):164.

    Article  Google Scholar 

  19. Micali G, Dall’Oglio F, Nasca MR. An open label evaluation of the efficacy of imiquimod 5% cream in the treatment of recalcitrant subungual and periungual cutaneous warts. J Dermatol Treat. 2003;14(4):233–6.

    Article  CAS  Google Scholar 

  20. Thi Minh PP, Pham Thi L, Tran LA. Early treatment with imiquimod 5% cream of periungual warts in Vietnam: the poorer, the better. Open Access Maced J Med Sci. 2019;7(2):214–6.

    Article  Google Scholar 

  21. Stefanaki C, Lagogiani I, Kouris A, et al. Cryotherapy versus imiquimod 5% cream combined with a keratolytic lotion in cutaneous warts in children: a randomized study. J Dermatol Treat. 2016;27(1):80–2.

    Article  CAS  Google Scholar 

  22. Ahn CS, Huang WW. Imiquimod in the treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol. 2014;15(5):387–99.

    Article  Google Scholar 

  23. Long FQ, Zhao LS, Qian YH. Vitiligo or vitiligo-like hypopigmentation associated with imiquimod treatment of condyloma acuminatum: not a casual event. Chin Med J (Engl). 2017;130(4):503–4.

    Article  Google Scholar 

  24. Chia-Han Yeh M, Tsai T, Huang Y. Intralesional vitamin D3 injection in the treatment of warts: a systematic review and meta-analysis. J Am Acad Dermatol. 2019;4:1013–5.

    Google Scholar 

  25. Priya A, Adil M, Amin SS, et al. Intralesional vitamin D3 in recalcitrant palmoplantar and periungual warts: a prospective, observational study. Acta Dermatovenerol Croat. 2019;27(4):215–24.

    CAS  PubMed  Google Scholar 

  26. Kareem IMA, Ibrahim IM, Mohammed SFF, et al. Effectiveness of intralesional vitamin D3 injection in the treatment of common warts: single-blinded placebo-controlled study. Dermatol Ther. 2019;32(3):e12882.

    Article  Google Scholar 

  27. Mohta A, Kushwaha RK, Gautam U, et al. A comparative study of the efficacy and safety of intralesional measles, mumps, and rubella vaccine versus intralesional vitamin D3 for the treatment of warts in children. Pediatr Dermatol. 2020;37(5):853–9.

    Article  Google Scholar 

  28. Fathy G, Sharara MA, Khafagy AH. Intralesional vitamin D3 versus Candida antigen immunotherapy in the treatment of multiple recalcitrant plantar warts: a comparative case–control study. Dermatol Ther. 2019;32(5):e12997.

    Article  Google Scholar 

  29. Broganelli P, Chiaretta A, Fragnelli B, et al. Intralesional cidofovir for the treatment of multiple and recalcitrant cutaneous viral warts. Dermatol Ther. 2012;25(5):468–71.

    Article  Google Scholar 

  30. Bik L, Sangers T, Greveling K, et al. Efficacy and tolerability of intralesional bleomycin in dermatology: a systematic review. J Am Acad Dermatol. 2020;83(3):888–903.

    Article  CAS  Google Scholar 

  31. Yazdanfar A, Farshchian M, Fereydoonnejad M, et al. Treatment of common warts with an intralesional mixture of 5-fluorouracil, lidocaine, and epinephrine: a prospective placebo-controlled, double-blind randomized trial. Dermatol Surg. 2008;34(5):656–9.

    CAS  PubMed  Google Scholar 

  32. Gonçalves JCA. 5-Fluorouracil in the treatment of common warts of the hands: a double-blind study. Br J Dermatol. 1975;92(1):89–91.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand

    Caroline Fenton & Connie Kang

Authors
  1. Caroline Fenton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Connie Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Connie Kang.

Ethics declarations

Funding

The preparation of this review was not supported by any external funding.

Authorship and conflict of interest

C. Fenton, a contracted employee of Adis International Ltd/Springer Nature, and C. Kang, a salaried employee of Adis International Ltd/Springer Nature, declare no relevant conflicts of interest. All authors contributed to the review and are responsible for the article content.

Ethics approval, Consent to participate, Consent for publication, Availability of data and material, Code availability

Not applicable.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fenton, C., Kang, C. Don’t despair over difficult-to-treat warts. Drugs Ther Perspect 37, 503–507 (2021). https://doi.org/10.1007/s40267-021-00871-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40267-021-00871-w

Search

Navigation