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Warts are small, benign growths caused by human papilloma virus (HPV) infection of the skin or mucous membrane. Photodynamic therapy in dermatology is simplified by the accessibility of the skin to light application and allows using any light source with the appropriate spectrum. This study aimed to compare the efficacy and safety of daylight-PDT versus pro yellow laser (577 nm)-PDT mediated by 10% methylene blue (MB) gel in the treatment of plane warts. This prospective comparative study was carried out on 34 patients presented with common warts (≥ 1 warts). Patients were divided into two equal groups by simple randomization process. Group 1: treated with daylight PDT using MB (MB-DL PDT), group 2: treated with Pro yellow laser as PDT using MB. The results of the present study revealed excellent response of warts in 9 patients (52.9%), very good response in 4 patients (23.5%) and poor response in 2 patients (11.8%) of group (1). In group (2), excellent response of the treated warts was observed in 5 patients (29.4%), poor response in 5 patients (29.4%) and no response in 7 patients (41.2%). Daylight-photodynamic therapy (DL-PDT) using MB is an effective treatment, nearly pain free and of convenience to patients. Careful consideration should be given to patient-specific factors such as immune status and previous treatment history. Future research with larger sample sizes, HPV genotyping, and longer follow-up periods is warranted to optimize patient-tailored PDT protocols., Competing Interests: Declarations. Ethical approval: The study was approved by an ethics committee of Faculty of Medicine (DFM-IRB 00012367-22-05-001) AL-Azhar University, Damietta; Egypt. Consent to participate: Written informed consents were received from participants or their guardians upon explanation of the study. Consent for publication: Not applicable, the manuscript does not contain any individual personal data. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Significance: Plantar warts, benign lesions on the soles of the feet, are caused by the human papillomavirus (HPV) infecting keratinocytes. Complete eradication of these warts is challenging, often leading to recurrences. This study evaluates the combined clinical efficacy of topical 5-aminolevulinic acid (5-ALA) photodynamic therapy (PDT) and fractional carbon dioxide (CO 2 ) laser treatment for recalcitrant plantar warts., Approach: Data from 10 patients with recalcitrant plantar warts were analyzed. Initially, thickened hyperkeratotic tissue was removed using a super-pulsed CO 2 laser. This was followed by fractional laser application, after which a 20 % 5-ALA cream was applied occlusively for 4 h. Patients then received He-Ne laser irradiation for 30 min at an energy density of 100 mW/cm², with treatments spaced 4 weeks apart., Results: The study included 10 participants aged 24 to 53 years (mean age: 33.4 ± 8.09 years). In total, 40 lesions were treated across 1 to 9 PDT sessions, with an average of 5.2 ± 2.86 sessions per patient. Complete clearance was achieved in 3 patients (30 %), 4 patients (40 %) showed an excellent response (≥80 % improvement), while 2 patients had a partial response. One patient (10 %) showed <50 % improvement. The overall clearance rate was 70 % (28 out of 40 lesions). Aside from temporary pain during the procedure and mild erythema post-treatment, one patient developed localized proliferative scarring. After a one-year follow-up, only one patient experienced recurrence., Conclusions: The combination of 5-ALA PDT and fractional CO 2 laser therapy shows promise as an effective and safe alternative for treating persistent plantar warts., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Management of plane warts is difficult; techniques like cryotherapy and cauterization are linked with a significant number of recurrences, risk of scarring, pain, and costs. To evaluate the effectiveness of TCA 30% solution in comparison with tretinoin 0.05% cream and5-flurouracil (5-FU) 5% cream in treatment of plane wart. A total of 100 patients were haphazardly divided into three groups according to the treatment: 34 patients treated with TCA 30%, 34 patients treated with tretinoin 0.05%, and 32 patients treated with 5-FU 5%. The number of lesions was calculated in all patients before treatment initiation. The efficiency of drugs was evaluated at 6 and 12 weeks after treatment during which the number of the warts in each patient and any side effects associated with the study concoction were recorded. According to the reduction in number of warts, response was categorized in to complete, partial and no response. After 6 weeks' treatment with TCA, Tretinoin and 5-FU, the lesion number reduced to 24%, 70.1% and 68.11% respectively with significant differences between TCA and other two groups. Similarly, after 12 weeks, the lesion number reduced to 14%, 51.67% and 26.86%, respectively with significant differences between TCA and other 2 groups. Additionally, hyper/hypopigmentation was more frequent in TCA treated group than tretinoin and 5-FU groups. Each of TCA, tretinoin and 5-FU are effective in treatment of plane wart, however; TCA seems to be more effective but associated with more pigmentary problems., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests. There is no conflict of interest to declare. Ethical approval: The protocol of the study was approved by Institutional Review Board (IRB) at the college of medicine-AL Nahrain University (approval no: 20240903). The Declaration of Helsinki's ethical standards were followed when doing the study project., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This comprehensive review article gives an up-to-date assessment of the therapeutic landscape for warts and molluscum contagiosum (MC), focusing on advances made in the last 5 years. New treatment choices include VP-102 (Ycanth) for molluscum contagiosum, potentially intralesional Vitamin D3 for warts, and topical cidofovir for both. Immunotherapy is regarded as a potential option, especially in difficult situations. Traditional therapies like cryotherapy and keratolytic medicines remain the principal options. The study emphasizes the need for personalized treatment strategies and additional research to improve therapy efficacy and safety., Competing Interests: Disclosure The authors declare no disclosures.. Authors’ contributions: K.K. Verma and K.M. Burningham wrote and revised the article and performed a literature review. S.K. Tyring revised the article. All authors approved the final article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Acral warts appear as skin-colored, verrucous, hyperkeratotic papules most located on the dorsal hands, distal fingers, subungual skin, and feet. Conventional photodynamic therapy (C-PDT) has shown a good efficacy and safety profile in patients with viral warts, in both adults and children, with a good cure rate and excellent cosmetic results in front of few and light side effects. The efficacy of daylight photodynamic therapy (DL-PDT) has not yet been evaluated., Objectives: to investigate and assess the short- and long-term efficacy of PDT using 10 % aminolevulinic acid (ALA) in the treatment of multiple verrucae vulgaris of the hands. The second endpoint was to compare the efficacy and safety of C-PDT versus DL-PDT., Materials and Methods: 68 patients (38 males and 30 females) aged between 6 and 80 years, affected by hand warts, were divided into two arms: group A was treated with C-PDT, and group B was treated with DL-PDT. Patients underwent treatments three times at 1-month intervals. The response was assessed 3 months after the last session (W24) and 1 year after the last session (W52) and scored as excellent (75-100 % reduction of total wart count), partial (74-25 % reduction), and none (< 25 % reduction or no response). Any adverse events occurring during or after ALA application or irradiation as well as pain intensity were recorded at each visit., Results: 48 patients (70.6 %) achieved excellent response at W24, while 6 patients (8.8 %) had a partial response and 14 (20.6 %) were resistant to treatment. Patients treated with DL-PDT were less likely to have an excellent response (66.7 %) than patients treated with C-PDT (73.7 %), although not statistically significant. Among patients with excellent or partial response (n=54), 37 % (n=20) had warts relapse at W52. Both treatment modalities were well tolerated, with transient pain as the main side effects., Conclusion: PDT is effective in the treatment of verrucae vulgaris of the hands. An overall response rate of 70.6 % of excellent response was achieved. While C-PDT showed a trend towards better outcomes, DL-PDT offered a more patient-friendly approach, particularly in terms of comfort and compliance., Competing Interests: Declaration of competing interest The authors declare no potential conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: WHIM (Warts, Hypogammaglobulinemia, Infections, and Myelokathexis) syndrome is an ultra-rare, combined primary immunodeficiency and chronic neutropenic disorder characterized by a range of clinical presentations, including peripheral neutropenia, lymphopenia, and recurrent infections. WHIM syndrome is most often caused by gain-of-function mutations in the gene encoding C-X-C chemokine receptor 4 (CXCR4). As such, inhibition of CXCR4 with XOLREMDI ® (mavorixafor), an orally bioavailable CXCR4 antagonist, demonstrated clinically meaningful increases in absolute neutrophil and lymphocyte counts and concomitant reduction in infections in patients with WHIM syndrome, resulting in its recent U.S. Food and Drug Administration approval. The impact of CXCR4 antagonism on other aspects of the pathobiology in WHIM syndrome, such as lymphopoiesis and leukocyte trafficking between primary and secondary lymphoid organs, is less understood., Methods: In the current study, the effects of CXCR4 antagonism on leukocyte trafficking and distribution in primary and secondary lymphoid organs were investigated in a mouse model of WHIM syndrome carrying the heterozygous Cxcr4 1013 mutation. Cxcr4 +/1013 and Cxcr4 wild-type mice received the orally bioavailable CXCR4 antagonist X4-185. Blood, spleen and bone marrow samples were collected for numeration, flow cytometry, and functional studies., Results: Cxcr4 +/1013 mice exhibited profound peripheral blood leukopenia as seen in patients with WHIM syndrome. CXCR4 antagonism corrected circulating leukopenia and mobilized functional neutrophils without disrupting granulopoiesis in the bone marrow of Cxcr4 +/1013 mice. Furthermore, Cxcr4 +/1013 displayed aberrant splenic T and B-cell counts and frequency. Treatment with X4-185 normalized splenic T-cell abnormalities, correcting the reduced CD8 + T-cell numbers, restoring the CD4/CD8 T-cell ratio, and ameliorating peripheral blood T-cell lymphopenia. In addition, CXCR4 antagonism was able to correct the abnormal frequencies and numbers of splenic marginal zone and follicular B cells in Cxcr4 +/1013 mice, and ultimately normalize B-cell lymphopenia in the peripheral circulation., Conclusions: Our study provides comprehensive evidence that oral dosing with a CXCR4 antagonist can effectively correct WHIM-associated neutrophil and lymphocyte abnormalities in a mouse model of WHIM syndrome. These findings extend our understanding of how targeting the dysregulated CXCR4 signaling pathway can ameliorate the pathogenesis of WHIM syndrome., Competing Interests: CN, KZ, HM, BM, RJ, and AT are employees and shareholders of X4 Pharmaceuticals. LR, MKh, MKa, BS, VG, VR, ZA, ME and KB had a research agreement with X4 Pharmaceuticals. The handling editor TT declared a past collaboration with the authors KZ and AT., (Copyright © 2024 Roland, Nguyen, Zmajkovicova, Khamyath, Kalogeraki, Schell, Gourhand, Rondeau, Abou Nader, Monticelli, Maierhofer, Johnson, Taveras, Espéli and Balabanian.)

A right-hand-dominant female presented 5 weeks following a right middle finger intralesional cantharidin injection for a common wart by a dermatologist. The patient experienced progressive stiffness, blistering, swelling, pain, and ultimately, full-thickness skin necrosis surrounding the injection site. Careful debridement followed by a full-thickness skin graft was performed with no evidence of involvement of the germinal matrix or terminal extensor tendon. At the 7-month postoperative mark, the patient's graft exhibited favorable healing and improved functionality that did not require further follow-up. Intralesional injection of cantharidin solutions for digital warts leads to progressive skin necrosis. Our case required prompt debridement and defect coverage. Involvement of the underlying anatomical structures was also a concern. Dermatologists and hand surgeons should be familiar with this complication as intralesional cantharidin injections are contraindicated.

Background: Plane warts, when multiple and recurrent, present a therapeutic challenge acting as a source of reinfection, causing frustration and affecting a patient's quality of life. For large numbers of lesions in cosmetically significant sites, topical treatment is preferred to avoid potential sequelae., Objectives: To evaluate and compare the efficacy and tolerability of tazarotene 0.1% gel vs. imiquimod 5% cream for the treatment of plane warts., Methods: In a parallel three-arm randomized controlled trial, 60 patients were randomized to imiquimod, tazarotene or placebo groups. Patients applied the corresponding treatment once daily at night for a maximum of 12 weeks. Primary outcomes were the percentage of respondents with complete clearance in the three studied groups, and the type and frequency of side-effects in each group., Results: Both active treatments resulted in significant improvement compared with baseline and the placebo group (P = 0.001). The imiquimod 5% treated group showed complete clearance in 50% (10/20) of patients, partial response in 15% (3/20), and no response in 35% (7/20). Tazarotene 0.1% gel showed complete clearance in 40% (8/20) of patients, partial response in 40% (8/20), and no response in 20% (4/20). No significant difference was detected between the imiquimod and tazarotene groups (P = 0.19)., Conclusions: Compared with imiquimod, tazarotene 0.1% gel for the treatment of plane warts seems to offer an equivalent treatment response, it maintained efficacy without recurrence and had a safer profile regarding dyspigmentation with an advantageous cheaper cost., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

A plantar wart is a benign hyperplasia that appears on the feet due to the human papillomavirus (HPV). One method used for the treatment of recalcitrant plantar warts, those lasting over 2 years or persisting after at least two treatment attempts, is the cantharidin (1%), podophyllin (5%), and salicylic acid (30%) formulation, also known as the CPS formulation. Although this method is in use, there are few studies on it. This study's objective was to ascertain its cure rate. For this retrospective observational study, we reviewed the medical records of patients treated with the CPS formulation at a podiatric clinic specializing in plantar wart treatment. Our sample size was 48 subjects. The CPS formulation had a cure rate of 62.5%. Out of the cured patients, 86.67% (26/30) required one or two applications. There was no observable correlation (p > 0.05) between wart resolution and virus biotype, evolution time, patient's morphological and clinical attributes, location, number of warts, or preceding treatments. The CPS formulation presents a relatively high efficacy rate for treating recalcitrant HPV plantar warts. Still, additional studies are necessary to evaluate its safety and efficiency., (© 2024 The Author(s). Journal of Medical Virology published by Wiley Periodicals LLC.)

Background: There are multiple conservative treatment options for plantar warts, but none have proven to be universally effective. Nitric acid is often used empirically by podiatrists in the treatment of plantar warts. A novel medical device or topical solution of nitric-zinc complex solution (NZCS) could potentially offer an effective and safe alternative for the targeted treatment of plantar warts., Objective: To observe the rate of complete healing of NZCS in a series of plantar wart cases and to establish the minimum number of product applications and time needed for healing. This will help standardize and protocolize its use., Methods: A descriptive study was conducted involving 72 patients who exhibited symptoms of plantar warts. These patients underwent chemical treatment using a nitric-zinc complex., Results: The cure rate with NZCS was 59.2%. The average number of NZCS applications was 5.9 ± 3.0 and the mean duration of treatment was 9.4 ± 7.1 weeks. A recurrence rate of 6.7% was observed., Conclusions: The topical solution of the nitric-zinc complex is an effective treatment for plantar warts, which can be considered a first-line treatment option in the general population.

Mavorixafor (XOLREMDI™) is an oral, selective C-X-C chemokine receptor 4 (CXCR4) antagonist developed by X4 Pharmaceuticals that blocks the binding of C-X-C chemokine ligand 12 (also known as stromal derived factor-1) to CXCR4. In April 2024, it became the first therapy to be approved for WHIM syndrome (named by an acronym for its observed characteristics of Warts, Hypogammaglobulinaemia, Infections and Myelokathexis) in the USA, where it is indicated for use in patients aged ≥ 12 years with WHIM syndrome to increase the number of circulating mature neutrophils and lymphocytes. Clinical development of mavorixafor is ongoing for chronic neutropenic disorders. This article summarizes the milestones in the development of mavorixafor leading to this first approval for use in patients aged ≥ 12 years with WHIM syndrome to increase the number of circulating mature neutrophils and lymphocytes., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Dedicator of cytokinesis 8 (DOCK8) deficiency represents a primary immunodeficiency with a wide range of clinical symptoms, including recurrent infections, atopy, and increased malignancy risk. This study presents a case of a 6-year-old girl with DOCK8 deficiency, characterized by severe, treatment-resistant herpetic infections who was successfully treated with siltuximab and glucocorticoids. The successful use of siltuximab in achieving remission highlights the pivotal role of interleukin-6 (IL-6) in DOCK8 deficiency pathogenesis and suggests that IL-6 modulation can be critical in managing DOCK8 deficiency-related viral infections, which may inform future therapeutic strategies for DOCK8 deficiency and similar immunodeficiencies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sun, Wei, Pan, Ni, Zhang, Guan, Cheng, Gu, Yu, He, Zhang, Yu and Yao.)

Abstract: We investigated efficacy and safety of mavorixafor, an oral CXCR4 antagonist, in participants with warts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome, a rare immunodeficiency caused by CXCR4 gain-of-function variants. This randomized (1:1), double-blind, placebo-controlled, phase 3 trial enrolled participants aged ≥12 years with WHIM syndrome and absolute neutrophil count (ANC) ≤0.4 × 103/μL. Participants received once-daily mavorixafor or placebo for 52 weeks. The primary end point was time (hours) above ANC threshold ≥0.5 × 103/μL (TATANC; over 24 hours). Secondary end points included TAT absolute lymphocyte count ≥1.0 × 103/μL (TATALC; over 24 hours); absolute changes in white blood cell (WBC), ANC, and absolute lymphocyte count (ALC) from baseline; annualized infection rate; infection duration; and total infection score (combined infection number/severity). In 31 participants (mavorixafor, n = 14; placebo, n = 17), mavorixafor least squares (LS) mean TATANC was 15.0 hours and 2.8 hours for placebo (P < .001). Mavorixafor LS mean TATALC was 15.8 hours and 4.6 hours for placebo (P < .001). Annualized infection rates were 60% lower with mavorixafor vs placebo (LS mean 1.7 vs 4.2; nominal P = .007), and total infection scores were 40% lower (7.4 [95% confidence interval [CI], 1.6-13.2] vs 12.3 [95% CI, 7.2-17.3]). Treatment with mavorixafor reduced infection frequency, severity, duration, and antibiotic use. No discontinuations occurred due to treatment-emergent adverse events (TEAEs); no related serious TEAEs were observed. Overall, mavorixafor treatment demonstrated significant increases in LS mean TATANC and TATALC, reduced infection frequency, severity/duration, and was well tolerated. The trial was registered at www.clinicaltrials.gov as #NCT03995108., (© 2024 American Society of Hematology. Published by Elsevier Inc. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

There are many therapeutic modalities for plantar warts, however treating it remains challenging. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide were observed to be effective and safe, however no comparison study between them was done. Our study was conducted to evaluate the efficacy of both therapies in the treatment of plantar warts. 90 adult patients with multiple recalcitrant plantar warts were included in our study. They were randomly allocated to one of three groups; combined digoxin and furosemide, 5-fluorouarcil, or normal saline group. Fortnightly injections were done into all studied warts till complete clearance or up to 5 sessions. Warts were evaluated clinically and dermoscopically. Clinical response was reported in 24 patients (80%) of the combined digoxin and furosemide group with 40% complete response and in 24 patients (80%) of the 5-fluorouarcil group with 33.3% complete response. No statistically significant difference was observed between the two groups concerning efficacy and safety. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide are nearly equivalent in efficacy and safety for plantar wart treatment. Dermoscopy helps to take the truthful judgment about complete clearance of warts., (© 2024. The Author(s).)

Objective: To observe the clinical effect of modified fire-needle technique and herbal bathing-repairing therapy of TCM on multiple verruca plantaris., Methods: Seventy patients with multiple verruca plantaris were randomly divided into an observation group (35 cases, 1 case was eliminated) and a control group (35 cases, 2 cases dropped out). In the control group, the herbal bathing-repairing therapy of TCM was adopted. In the observation group, besides the treatment as the control group, fire needling and cauterization were delivered on the base of skin lesion or the sites with rich blood vessels under the dermoscope. The intervention was provided once a week, one course of treatment was composed of 3 weeks, and two courses were required in each group. The score of the self-designed symptom scale, the score of dermatology life quality index (DLQI) and the area of typical skin lesion were observed before and after treatment. The clinical effect was evaluated after treatment and the recurrence was assessed 2 months after treatment completion in the two groups., Results: After treatment, the scores of the self-designed symptom scale and DLQI were lower and the area of typical skin lesion was smaller compared with those before treatment in the two groups ( P <0.05). The scores of the self-designed symptom score and DLQI in the observation group were reduced ( P <0.05), and the area of typical lesion was smaller ( P <0.05) in comparison with those in the control group. The total effective rate was 91.2% (31/34) in the observation group, higher than that in the control group (60.6%, 20/33, P <0.05). The recurrence rate was 6.5% (2/31) in the observation group, lower than that in the control group (35.0%, 7/20, P <0.05)., Conclusion: Modified fire-needle technique combined with herbal bathing-repairing therapy ameliorates clinical symptoms and the quality of life in the patients with multiple verruca plantaris and reduces the recurrence of the disease.

Treating plantar warts is still a challenging problem with a long list of diverse treatment options that none of them seems to be definitive. To evaluate the effectiveness of intralesional acyclovir versus intralesional Hepatitis-B vaccine (HBV) in treatment of multiple resistant plantar warts. Forty-eight patients with resistant plantar warts completed the study with no dropouts. They were randomized into 3 groups; group(A) receiving intralesional HBV, group (B) receiving intralesional acyclovir and group (C) receiving intralesional saline as a control group over 5 biweekly sessions or until wart clearance. Clinical outcome was assessed through sequential digital lesion photographing upon each visit. Treatment related adverse reactions were recorded. 43.8%, 37.5% & 18.7% of Groups A, B &C respectively showed a complete response. pain was obvious in 100% and 56.3% of cases receiving intralesional acyclovir and HBV respectively. Up to the 6 month follow up period, none of the complete responders in all groups returned with a recurrence. Both acyclovir and HBV showed comparable efficacy and seem to be promising options for treating plantar warts being safe, affordable, and theoretically safe in immunocompromised cases., (© 2024. The Author(s).)

Introduction: Recalcirant warts are resistant to conventional therapeutic option with high recurrence rate. In recent year, treatment of warts with different immunotherapeutic agent has shown good results, as it regulate epidermal cell proliferation and are involved in the formation of anti microbial peptides. Hence, this study was undertaken to evaluate the efficacy of immunotherapy with intralesional vitamin D in wart., Methods: A descriptive cross-sectional study was conducted from 1 January 2021 to 2 February 2023 at Kathmandu Medical College after approval from the Institutional Review Committee (Reference number: 0110202002). Ninety - two patients with recalcitrant wart of varying sizes and duration were included in the study. Injection vitamin D ( 600000 IU, 15mg/ ml) was injected about (0.2-0.5 ml) to the base of the wart. Maximum of five warts were injected per month, and was repeated after 4 weeks for 3 sessions., Results: Among 92 patient, complete response was seen in 70 patient (76.08%), partial response was seen in 17 patients ( 18.47%) and 5 patient(5.43%)showed no response. Mild pain as observed at the time of injection. Signs of hypervitaminosis D was not observed., Conclusions: Intralesional administration of Vitamin D is an effective treatment option for reclacitrant warts and is, highly effective, cost-efficient, with minimal adverse effects, and can be perfomed in our clinical set up.

Plantar warts are common skin lesions that continue to represent a therapeutic challenge. They are still resistant to therapy and are highly recurrent, despite the diverse number of treatments available. Therapies targeting vasculature, such as pulsed dye laser, have been used successfully in the treatment of plantar warts. Polidocanol, a detergent sclerosant approved for the sclerotherapy of incompetent and dilated saphenous veins, has also been used as an off-label therapy for a wide range of skin conditions with vascular components such as hemangiomas and pyogenic granuloma. The current, open-label, prospective, pilot study aimed to evaluate the safety and efficacy of the intralesional polidocanol 3% in the treatment of plantar warts. Twenty patients (11 females and 9 males), with plantar warts, aged 12-50 years received biweekly sessions of intralesional polidocanol 3% until complete clearance or for a maximum of 6 sessions. Response to treatment was graded as complete (100% clearance), partial (50-99%), and no response (< 50%). At the end of the study, 12 (60%) patients achieved complete clearance of their warts after 1-5 sessions, 5 (25%) patients had only partial response, and 3 (15%) patients did not achieve any clearance of their warts. The procedure was largely tolerable by patients. Pain at the injection site and bruises were reported by 9 (45%) and 2 (10%) patients, respectively. Both side effects resolved spontaneously and completely within a few days. The findings of the current study suggest that intralesional injection of 3% polidocanol in biweekly sessions may be a safe, effective, and tolerable method for the treatment of plantar warts., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Common cutaneous non-genital viral warts are a common skin infection with significant morbidity in the pediatric population. Although various therapeutics are available, many of them necessitate recurrent patient visits and may be associated with significant irritation and pain. Verrulyse Methionine ® (VM), a nutritional supplement, was previously suggested as a non-invasive treatment option for the disease., Objective: To assess the response to oral VM supplement as a monotherapy in a cohort of children and adolescents with multiple, non-genital viral warts after failing previous treatments., Methods: We reviewed medical records of pediatric patients (<18 y/o) with viral warts treated with VM between 2010 and 2021., Results: Among 25 patients with multiple verrucae vulgaris lesions who failed previous treatments, 14 (56%) had complete or almost-complete response to VM within 4 months, after an average of 18 months of active disease prior to VM treatment initiation. None of the 4 patients with verruca plana had response to VM treatment. Favourable cosmetic results were found in responders, and no adverse events were recorded., Conclusion: Response rates in our cohort are comparable to those reported in the literature for destructive local therapeutics for viral warts. Thus, our data suggest that VM may be considered for children with multiple verrucae vulgaris, providing a painless and non-invasive therapeutic option for this common disease., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Plantar wart is one of the most recalcitrant types of cutaneous warts with a high recurrence rate. Recalcitrant plantar warts are resistant to traditional treatments such as cryotherapy. Photodynamic therapy (PDT) is a modern, non-invasive method utilized to treat benign and malignant skin disorders. Several previous studies have reported the effective application of PDT treatment for plantar warts. We reported three cases of recalcitrant plantar warts successfully treated with PDT., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Background: Verrucae are benign proliferations caused by human papillomavirus. Treatment is needed for pain, bleeding, contagiousness, and cosmetically., Aims: The aim of this study is to evaluate the effectiveness of KTP laser treatment in verrucae, as well as side effects and recurrence rates., Patients and Methods: Patients who had Verrucae vulgaris (V. vulgaris) and Verrucae plantaris (V. plantaris) previously treated with KTP laser were scanned for their eligibility. Twenty-nine patients who met the inclusion criteria were included. There was complete recovery in 24 patients (82.8%) and partial recovery in two patients (6.9%). Three patients (10.3%) were unresponsive to treatment after six sessions (no recovery). Two patients had mild pain during the application, and 65.4% of the patients had complete cosmetic recovery at the 3rd month follow-up., Results: As a result, we found that the standard KTP laser can be an effective option for both types of verrucae., Conclusions: We think KTP laser treatment can be preferred for verrucae treatment., (© 2023 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

Background: Warts result from an infection with the human papilloma virus (HPV). Plantar warts, also known as Verruca plantaris, can be notably painful for the patient and possess contagious qualities, thus necessitating assertive treatment. Despite several available approaches for addressing plantar warts, efficacy remains elusive., Case Presentation: One 22-year-old firefighter suffered from numerous plantar warts. After 26 days of traditional Chinese medicine soaking, the rashes completely disappeared. The treatment was without complications or discomfort, and a three-month follow-up showed no recurrence., Conclusion: Our case investigation highlighted the efficacy of herbal soaking as a safe, painless, and non-invasive therapeutic option, positioning it as a potential avenue for managing multiple plantar warts., (Copyright © 2023. Published by Elsevier Inc.)

Cutaneous warts are an exceedingly common cutaneous viral infection for which existing treatment options are often painful, expensive, and only marginally effective. Extensive warts may occur in the setting of primary immunodeficiencies, wherein they can co-occur with other diseases of immune dysfunction, such as atopic dermatitis (AD). Dupilumab, an IL-4 receptor α (IL-4Rα)-blocking monoclonal antibody, is a biologic agent recently approved for the treatment of moderate-to-severe eczema. Here, we report a case of a young girl with both severe AD and diffuse filiform warts, which resolved shortly after initiating treatment for AD with dupilumab., (© 2023 Wiley Periodicals LLC.)

Background: Plantar warts, or verruca plantaris, are common cutaneous lesions of the plantar surface caused by the human papilloma virus (HPV) infection. Current treatments include salicylic acid, cryotherapy, bleomycin, and immunotherapy; however, they have limitations of low-cure rates or side effects. Plantar warts treated with bee venom (BV) have not been reported. Here we present a case of a patient who showed complete remission of multiple plantar warts after BV treatment., Case Presentation: A 13-year-old boy experienced total of 16 plantar warts and visited department of dermatology of Korean Medicine. BV was injected into wart sites. Warts were completely removed at the end of the 8-week treatment with no adverse event recorded. There was improvement during the follow-up after 4 weeks., Conclusion: This is the first case of plantar warts that improved with BV injection. This study suggests that BV may be a therapeutic option for individuals who cannot receive cryotherapy due to pain during and after treatment or who have refractory or relapsed warts., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2023. Published by Elsevier Inc.)

Background: Plantar warts are common infectious cutaneous growths causing severe physiological and psychological discomforts in patients and heaving global financial burdens. However, paucity of clear-cut guidelines for plantar warts, selecting appropriate treatments for plantar warts remains challenging. The objective of the study is to evaluate the efficacy and safety of common treatments for plantar warts., Methods: PubMed, EMbase, and The Cochrane Library were searched from inception to March 1, 2023 for randomized controlled trials (RCTs) of plantar warts. The primary outcome (complete response) and secondary outcome (recurrence and pain) were extracted and combined using Bayesian network meta-analysis (NMA) with random-effect and fixed-effect models., Results: Totally, 33 RCTs were included in the systematic review and quantitative NMA. In NMA of complete response, topical application of 1% cantharidin, 20% podophylotoxin, 30% salicylic acid (CPS), microneedles plus bleomycin (MNB), and intralesional bleomycin injection (INB) were the only three treatments significantly superior to no treatment (NT) and CPS was of the highest possibility to be the top-ranked treatment (SUCRA = 0.9363). However, traditional warts treatments, salicylic acid (SA) and cryotherapy were not superior to NT., Conclusions: The NMA has produced evidence for using CPS, MNB, and INB, which are all topical antimitotic treatments, to improve the management of plantar warts. The classic treatment modalities for plantar warts, including SA and cryotherapy, may play a less important role in the clinical practice of plantar warts., (© 2024 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.)

Photodynamic therapy (PDT) uses light energy to excite a photosensitizing agent, leading to production of reactive oxygen species, which exert cytotoxic effects on targeted cells. PDT has emerged as a promising therapeutic modality for the treatment of flat warts caused by human papillomavirus (HPV) infection, by targeting infected keratinocytes and inactivating nonenveloped viral particles. Some patients with recalcitrant flat warts on the face who have poor response to traditional treatment often seek effective therapy to have the warts removed. In this report, we retrospectively evaluated the efficacy of topical 10% 5-aminolevulinic acid PDT (ALA-PDT) in the treatment of 15 patients with recalcitrant facial flat warts. Patients received treatment once every two weeks for a total of two or three sessions. At 24 weeks after the start of treatment, 86.67% of patients showed complete or excellent response. Further more, the remission rate of 100% lesion clearance was 46.67% (seven patients), and the remission rate of 70-100% lesion clearance was 40.00% (six patients). None of the patients experienced disease recurrence or progression. The adverse reactions were generally well tolerated by the patients and mostly resolved in a few days without special treatment. Our findings showed that topical 10% ALA-PDT is a safe and effective treatment for recalcitrant facial flat warts., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

Verruca vulgaris, caused by the human papillomavirus (HPV), can profoundly impact an individual's quality of life and necessitate therapeutic intervention. The challenges associated with treating verruca vulgaris are particularly noteworthy when they manifest as the Koebner phenomenon (KP). In this report, we present two cases of verruca vulgaris that developed KP following cryotherapy. Some studies have suggested that pretreatment with laser therapy enhances the efficacy of Photodynamic Therapy (PDT). Given the inefficacy of cryotherapy and the emergence of KP in our patients, we opted for a treatment approach that combined PDT with CO 2 fractional laser (CO 2 FL), resulting in complete resolution without any notable adverse effects or recurrence during the follow-up period. Our cases underscore the importance of considering KP when verruca vulgaris exhibit enlargement and proliferation post-cryotherapy. Furthermore, this combined treatment modality demonstrates its effectiveness and safety. Additionally, our experience highlights the need for a large-scale study to determine the optimal photosensitizer concentration for the treatment of thick, enlarged verruca vulgaris., Competing Interests: Declaration of Competing Interest There are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: Multiple palmoplantar warts, caused by human papillomavirus (HPV) infection, were investigated for clinical efficacy using cantharidin, retinoic acid cream, and salicylic acid cream., Methods: A total of 110 patients with multiple palmoplantar warts were enrolled. The experimental group (54 cases) received a 1:1:1 combination (CRS) of 0.25% cantharidin, 0.1% retinoic acid cream, and 5% salicylic acid, applied with pressurized encapsulation for 8 h every night, three times per week. The control group (56 cases) underwent conventional liquid nitrogen freezing. Monthly follow-ups assessed cure rate, effective rate, dermatological life quality index (DLQI), visual analog scale (VAS), and cost, with evaluations conducted after 3 months., Results: The treatment group exhibited a cure rate of 85.19% and a total effective rate of 96.30%, surpassing the control group with rates of 39.29% and 51.79%, respectively (p < 0.05). The treatment group's DLQI score (1.84 ± 1.06) was significantly lower than the control group's score (6.04 ± 1.78) (p = 0.0005). Additionally, the treatment group's VAS score (1.84 ± 1.06) was notably lower than the control group's score (8.56 ± 1.07) (p < 0.0001). The treatment group's total cost (43.20 ± 2.85) was markedly lower than the control group's cost (206.38 ± 90.81), with a statistically significant difference (p < 0.0001)., Conclusion: The combination of cantharidin, retinoic acid cream, and salicylic acid with local encapsulation is a safe, effective, economical, and convenient treatment method for multiple palmoplantar warts, exhibiting few side effects and showing promise., (© 2024 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd.)

Cantharidin (YCANTH™) is a proprietary drug-device combination product containing a formulation of cantharidin 0.7% topical solution (a vesicant naturally derived from blister beetles) delivered via a single-use applicator that has been developed by Verrica Pharmaceuticals Inc. for the treatment of molluscum contagiosum and is also being developed for the treatment of warts. In July 2023, YCANTH™ (cantharidin 0.7% topical solution) was approved for the topical treatment of molluscum contagiosum in adult and pediatric patients 2 years of age and older in the USA. This article summarizes the milestones in the development of cantharidin 0.7% topical solution leading to this first approval for the topical treatment of molluscum contagiosum in adult and pediatric patients 2 years of age and older., (© 2023. Springer Nature Switzerland AG.)

Mosaic warts are a type of verruca vulgaris that occur almost exclusively on the soles of the feet. They are particularly known for their treatment resistance and high recurrence rate. Laser-assisted drug delivery (LADD) photodynamic therapy (PDT) with methyl aminolevulinate (MAL) offers a low pain treatment option with hardly any side effects in therapy-resistant cases of verruca plantaris. Pretreatment with an ablative fractional laser is especially important to obtain penetration of MAL through the human papillomavirus (HPV)-infected skin layer., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: Successful treatment of periungual warts presents a clinical challenge, as many are refractory or represent following conventional treatments. The use of destructive therapies, such as cryotherapy, may even cause permanent nail dystrophy. Materials and methods: Here, we present a series of nine cases in which intralesional cidofovir was used for recalcitrant periungual warts between July 2020 and July 2022 at the University of California, Los Angeles. Results: Following a mean of 2.7 treatments (SD = 0.87), 100% of patients ( n  = 9) saw improvement in the appearance of their warts, and 77.8% ( n  = 7) had near to complete resolution. Few self-resolving local reactions occurred, including pain, edema, erosion, blister formation, and discoloration at the proximal nail fold. All reactions resolved within weeks of treatment and required no additional treatment. Conclusions: Intralesional cidofovir treatment of recalcitrant periungual warts is well tolerated and provides unmatched results. Given the risks of traditional therapies to the nail, intralesional cidofovir should be considered as a first-line therapy for periungual warts. Randomized clinical trials are necessary, in the future, to adequately understand the effectiveness of intralesional cidofovir.

Competing Interests: Conflicts of interest None disclosed.

Human papillomavirus (HPV) is ubiquitously distributed in the population worldwide and its most frequent clinical presentation is cutaneous warts. Despite various treatment options currently available, many patients experience persistent and refractory disease. We sought to evaluate the clinical effectiveness and safety profile of intralesional HPV 9-valent vaccine for the treatment of recalcitrant warts. A retrospective study was performed for all cases of cutaneous warts treated with intralesional 9-valent HPV vaccine between January 2017 and March 2021. Epidemiologic, clinical, and treatment data, including safety and effectiveness scores, were reviewed. Our cohort was composed of 20 patients: 13 adults and seven children. Twelve patients (60%) displayed a complete response whereas 8 patients (40%) showed a partial response. Older age was associated with a better response to treatment, while a history of laser therapy was associated with a worse prognosis. Adverse events were local, transient, and negligible. No systemic adverse effects were reported. Intralesional 9-valent HPV vaccine may be considered for the treatment of recalcitrant cutaneous warts. Controlled studies are required to confirm these results., (© 2023 The Authors. The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

Numerous studies have investigated the efficacy of intralesional immunotherapy for warts, but there are a lack of studies investigating the efficacy of alternative intralesional immunotherapies following failure of initial intralesional immunotherapy. In this retrospective study, we aimed to investigate the efficacy of intralesional measles, mumps, and rubella vaccine for the treatment of pediatric warts following failure of intralesional therapy with Candida antigen. Following intralesional measles, mumps, and rubella vaccine administration, 8/51 (15.5%) patients had complete resolution of their warts, 6/51 (12%) had near complete resolution, 19/51 (37%) had partial improvement, 12/51 (23.5%) had no change, and 6/51 (12%) had worsening. Although limited by retrospective nature and low sample size, our results demonstrate that intralesional immunotherapy with measles, mumps, and rubella vaccine provides an alternative therapeutic option for the treatment of recalcitrant pediatric warts in patients who fail to respond to intralesional Candida antigen., (© 2023 Wiley Periodicals LLC.)

BACKGROUNDWarts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome is a primary immunodeficiency disorder caused by heterozygous gain-of-function CXCR4 mutations. Myelokathexis is a kind of neutropenia caused by neutrophil retention in bone marrow and in WHIM syndrome is associated with lymphopenia and monocytopenia. The CXCR4 antagonist plerixafor mobilizes leukocytes to the blood; however, its safety and efficacy in WHIM syndrome are undefined.METHODSIn this investigator-initiated, single-center, quadruple-masked phase III crossover trial, we compared the total infection severity score (TISS) as the primary endpoint in an intent-to-treat manner in 19 patients with WHIM who each received 12 months treatment with plerixafor and 12 months treatment with granulocyte CSF (G-CSF, the standard of care for severe congenital neutropenia). The treatment order was randomized for each patient.RESULTSPlerixafor was nonsuperior to G-CSF for TISS (P = 0.54). In exploratory endpoints, plerixafor was noninferior to G-CSF for maintaining neutrophil counts of more than 500 cells/μL (P = 0.023) and was superior to G-CSF for maintaining lymphocyte counts above 1,000 cells/μL (P < 0.0001). Complete regression of a subset of large wart areas occurred on plerixafor in 5 of 7 patients with major wart burdens at baseline. Transient rash occurred on plerixafor, and bone pain was more common on G-CSF. There were no significant differences in drug preference or quality of life or the incidence of drug failure or serious adverse events.CONCLUSIONPlerixafor was not superior to G-CSF in patients with WHIM for TISS, the primary endpoint. Together with wart regression and hematologic improvement, the infection severity results support continued study of plerixafor as a potential treatment for WHIM syndrome.TRIAL REGISTRATIONClinicaltrials.gov NCT02231879.FUNDINGThis study was funded by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases.

Objective: To evaluate the effectiveness of intralesional bleomycin in comparison to cryotherapy in the treatment of cutaneous warts., Methods: The randomized controlled trial was conducted at the Department of Dermatology, Jinnah Postgraduate Medical Centre, Karachi, from January to July 2021, and comprised patients of either gender aged 18-60 years who had cutaneous warts for 1-48 weeks. The subjects were divided into group A treated with 0.1% intralesional bleomycin, and group B were treated with cryotherapy through non probability consecutive sampling. Follow-up examination was done at the 2, 4 and 6 weeks. Data was analysed using SPSS 23., Results: Of the 154 patients, 96(62.3%) were male and 58(37.7%) were females. The overall mean age was 33.253±6.726 years. There were 77(50%) patients in each of the two groups. The therapy after 6 weeks was found to be effective 73(94.8%). group A patients and 57(74%) group B patients (p=0.001)., Conclusions: Intralesional bleomycin was found to be more successful than cryotherapy in the treatment of cutaneous warts.

Introduction: Cutaneous warts are one of the most frequent reasons for visits to the dermatologist. While there are many treatment options available and commonly used to treat warts, recurrence of lesions is common and complete clearance is rarely achieved. Cidofovir is an antiviral agent that has activity against various DNA viruses, including HPV, the virus that results in verrucae., Objective: We examined the literature on the use of cidofovir in the treatment of non-genital warts to further assess its safety and efficacy.&nbsp; Methods: A review of the literature using PubMed and Google Scholar databases was conducted to find relevant case reports and studies on the use of cidofovir in the treatment of non-genital warts.&nbsp; Results: Thirteen case reports, five case series, six retrospective chart reviews, and one clinical study were reviewed and included. There were a total of 603 patients, 46.2% males and 53.7% females. Of 603 patients included in this review, 212 (35.2%) were treated with topical cidofovir for their warts. Clearance was achieved in 55.2%. There was no recurrence of lesions after clearance at two months to three years post-treatment (mean of 15.8 months). Of the 212 patients treated with topical cidofovir, 37 (17.4%) reported local side effects such as erythema, pruritus, and burning.&nbsp; Discussion/Conclusion: Treatment options for recalcitrant non-genital warts are limited and have varying efficacy. Topical cidofovir may serve as an effective, safe, and affordable alternative for the clearance of recalcitrant non-genital warts, but controlled clinical trials are needed.J Drugs Dermatol. 2023;22(10):1009-1016&nbsp; doi:10.36849/JDD.7258.

Background: Pediatric oncology patients undergoing cancer treatment can often have numerous and recalcitrant cutaneous warts due to their underlying immunosuppression. There are little published data on the optimal management of warts in pediatric oncology patients undergoing active cancer treatment compared to patients having completed treatment. Our objective was to analyze the clinical course of warts treated within this patient population at Boston Children's Hospital over a 10-year period., Methods: This was a single-institution retrospective study of 72 pediatric oncology patients from 1 September 2011 to 1 September 2021 who were treated for warts at Boston Children's Hospital. All patients had a diagnosis of cutaneous warts with at least one follow-up visit and were receiving active treatment for cancer either during or after concurrent treatment of their warts. We examined the modality and effectiveness of wart treatments while both on and offactive treatment of their cancer., Results: The median age was 12 years (range 4-18). Fifty-four percent of patients were documented to have plantar warts. Sixty percent of patients with a documented number of warts had more than five warts at presentation. For cases in which outcomes were specified, treatment resulted in complete resolution of warts in only 24.0% of patients undergoing active cancer treatment compared to 63.3% of patients not on active treatment. Warts persisted or worsened in 56.0% of patients undergoing active cancer treatment compared to only 13.4% of patients not on active treatment., Conclusion: These data may help guide clinicians in evaluating and treating warts in pediatric oncology patients., (© 2023 Wiley Periodicals LLC.)

Background: The human papillomavirus that causes warts is usually harmless, and it can infect any part of the skin or mucous membranes. Despite the availability of several treatments, warts often return, and scarring, pigmentation changes, and recurrence are all possible side effects., Aim: Intralesional vitamin D3 was employed as an immunotherapy for cutaneous warts in the current investigation., Materials and Methods: In Al-Sadr Medical City in the city of Al-Najaf Al-Ashraf, a skin clinic conducted a therapeutic clinical experiment. A total of 204 cutaneous warts were examined in 40 patients (14 men and 26 females). Vitamin D3 solution of the dose (600 000 IU) was injected into the lesions' bases, with 0.2 mL per patient. Each session could only inject up to five warts. The injections were given every 2 weeks for a total of four times. Instructing patients to forego the use of any topical or oral medication was also a part of the protocol. Each patient was evaluated for recurrence risk before each therapy and then again 6 months later., Result and Discussion: There was a wide range of patient ages in this study, from 20 months to 52 years. About 65% of the cases included females. When looking at the many kinds of warts, the most prevalent was the common wart (71.6%). After four treatments, a positive response was considered to have occurred when all lesions had disappeared, a partial response when more than half of the lesions had disappeared, and no reaction when less than half of the lesions had disappeared. The final tally was 81.9% for those who responded in whole, 11.3% for those who responded partially, and 6.9% for those who did not respond at all. Next-session complete response rates were 12.7%, 29.9%, 54.9%, and 81.9%, respectively. Thirteen people experienced adverse symptoms, most noticeably minor swelling and itching. Within 6 months of follow-up, warts had completely disappeared for all patients with a partial or modest response except one who had no reaction., Conclusion: Vitamin D3 administered intralesional is an effective and low-cost treatment for cutaneous warts., (© 2023 The Authors. Skin Research and Technology published by John Wiley & Sons Ltd.)

Background: Many therapeutic modalities are available for treating genital warts; however, the effectiveness of both diphenylcyclopropenone and podophyllin is still controversial., Aim: To evaluate the effectiveness and safety of diphenylcyclopropenone and podophyllin in treating genital warts., Methods: This study included 57 patients, divided randomly into two groups. Group (A): diphenylcyclopropenone ( n = 29). Group (B): podophyllin 25% ( n = 28). In group (A), sensitization was done with 2% diphenylcyclopropenone. Then, after 1 or 2 weeks, treatment started with a weekly application of diphenylcyclopropenone solutions ranging between 0.001 and 1% until clearance, or for a maximum of 10 sessions. In group (B), podophyllin 25% was applied weekly until clearance or for a maximum of 6 weeks., Results: Higher clearance was achieved in group A, with 19 of 29 (65.5%) patients, than in group B, with 9 of 28 (32.1%) ( p -value = 0.004). Also, effectiveness increases with young age in group A. Shorter wart duration was associated with better response in both groups ( p -value = 0.005). No serious adverse effects occurred in either group. No recurrence was detected in group A, while seven patients (77.8%) had recurrence in group B after 1 year of follow up., Conclusion: Diphenylcyclopropenone shows a higher success rate than podophyllin in treating genital warts and a lower recurrence rate.

Common warts are benign skin lesions caused by the human papillomavirus. Although they are usually not harmful, they can cause pain, depending on their location. While many modalities are available for treatment of warts, none is a gold standard, and many are not affordable and/or have suboptimal outcomes. Trichloroacetic acid (TCA) is a chemical tissue-destroying agent used as a highly concentrated solution for wart management. While available and efficient, it is difficult to handle as the solution spreads to tissue surrounding the wart causing pain and burning. Hence, we developed a new polymer-based gel of high TCA content (100% w/v). Gels were formed successfully as hydroxyethyl cellulose (HEC) and chitosan were used to impart viscosity and bioadhesion. Formulae of different concentrations were tested for their physical properties, and the optimal formulation was selected for clinical evaluation. A combination of 3% HEC and 2% chitosan provided optimal viscosity and limited water content and have acceptable stability. The efficacy and safety of the biweekly application of TCA gel were evaluated in 30 patients. The clinical study revealed gel's efficacy and tolerability; half of the patients showed a complete cure, and 90% showed improvement within 6 weeks. Only 10-12% of the patients reported side effects. In summary, transforming TCA solution into a gel enabled its application and handling in a practical manner by physicians and patients alike, while maintaining its efficacy as a tissue-destroying agent. Moreover, it is economic and easy to apply, rendering it a promising formulation for similar conditions requiring controlled tissue ablation., (© 2023. The Author(s), under exclusive licence to American Association of Pharmaceutical Scientists.)