Warts

Treatment

 

Hyperthermia

​Clearance of multiple cutaneous warts by targeting a single lesion: A randomized comparative evaluation of mild local hyperthermia versus cryotherapy. J Am Acad Dermatol. 2022. PMID: 35934211.

SUMMARY: RCT of local hyperthermia at 44C for 30 min, 3 consecutive days one week followed by 2 consecutive days two weeks later followed by weekly treatment for 2 sessions (7 total treatments) versus cryotherapy applied with a cotton tipped applicator 3 times in a month separated by 2 week intervals.  Patients with multiple common warts, plantar warts, or condyloma acuminata were included.  The same wart was treated at each session and the rate of clearance of other non-treated warts was observed.  No difference in the rate of clearance of the treated wart was observed between hyperthermia and cryotherapy.  54.5% of the hyperthermia treated patients had complete wart clearance versus 27.2% of the cryotherapy treated patients (p<0.01).  Pain was significantly worse in the cryo group.  The difference could certainly be attributed to under-treatment of cryotherapy arm given modality of cryotherapy delivery chosen. 

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HPV Vaccination

• Although the two studies below show evidence supporting the use of HPV vaccination for warts, systematic reviews have not shown convincing efficacy (need citations, and more comprehensive review.  big distinction between IL HPV and HPV vaccination). 

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Nofal A, Nofal H, Alwirshiffani E, ElGhareeb MI. Treatment response and tolerability of intralesional quadrivalent versus bivalent human papillomavirus vaccine for recalcitrant warts: A randomized controlled trial. J Am Acad Dermatol. 2023. PMID: 37422014.

MY SUMMARY: 50 patients were randomized to IL quadrivalent (20), IL bivalent (20), and IL saline (10).  0.1ml was injected into a single wart (largest) every 2 weeks until clearance or up to 5 treatments.  18 of 20 in the quadrivalent group, 6 of 20 in the bivalent group, and 0 of 10 in the saline group experienced complete clearance. 

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The human papillomavirus vaccine as a treatment for human papillomavirus-related dysplastic and neoplastic conditions: A literature review. J Am Acad Dermatol. 2020. PMID: 31085272.

CONCLUSION: The commercially available three-dose, quadrivalent HPV vaccine is a potential therapeutic option for the treatment of cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas. Noncommercially available HPV vaccines demonstrate therapeutic response for treating anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia. The vaccine’s efficacy as an adjunct therapy for HPV-associated cutaneous and/or mucosal disease warrants further exploration.

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Intralesional versus intramuscular bivalent human papillomavirus vaccine in the treatment of recalcitrant common warts. J Am Acad Dermatol. 2020. PMID: 31369771.

CONCLUSION: Bivalent HPV vaccine, particularly by intralesional injection, seems to be a potential therapeutic option for the treatment of multiple recalcitrant common warts.

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Home Remedies​

Pinto Bean Pressure Wraps: A Novel Approach to Treating Digital Warts. Cutis. 2024. PMID: PMID: 39787310.

This article introduces a simple, low-cost home treatment for common digital warts using dried pinto beans as pressure applicators.  It is a descriptive case-based narrative outlining the method. They provide only anecdotal observations stating that "most warts resolve with this technique" and recurrence is "similar to that for cryotherapy."​ The method involves taping a small, hard, convex object—preferably a pinto bean—over the wart and securing it with a self-adherent wrap overnight. The sustained pressure induces ischemia (restricted blood flow), which selectively damages wart tissue, allowing it to slough off within 1–2 weeks. The technique is described as nearly pain-free and has recurrence and response rates similar to conventional methods like cryotherapy.

• Rationale: Warts contain tortuous blood vessels that are more susceptible to ischemia than normal skin.

• Advantages: Low cost, no need for clinical visits, minimal discomfort, and minimal risk of scarring.

• Effectiveness: Most warts resolve with one to three nightly applications. Recurrence rates are comparable to cryotherapy. This is claimed by the authors but they do not provide data regarding this. 

• Limitations: Ineffective on non-digital warts due to difficulty maintaining pressure. (May be Not suitable for patients with compromised circulation (e.g., Raynaud's, systemic sclerosis).

• Safety: Caution against choking hazards and allergic reactions; beans must remain dry and should not be ingested.

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