Clearance Of Warts Research Articles

Intralesional combined digoxin and furosemide versus intralesional 5-flurouracil for the treatment of recalcitrant plantar warts: a prospective, randomized study

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.

Intralesional acyclovir versus intralesional Hepatitis-B vaccine in treatment of resistant plantar warts: a randomized controlled trial

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.

Efficacy of Intralesional Candida Antigen Versus Measles, Mumps, and Rubella Vaccine Versus Topical Podophyllin in Treatment of Resistant Genital Warts.

No single treatment is ideal for genital warts with high rate of resistance using conventional modalities as topical podophyllin; however, several intralesional immunotherapies are being tested nowadays, with variable results. In this study, we compared the safety and efficacy of treating resistant and recurrent genital warts by 2 intralesional immunotherapies [Candida antigen and measles, mumps, and rubella (MMR) vaccine] and compared them with topical podophyllin. A total of 45 patients with resistant or recurrent genital warts were enrolled in this study. Size and number of warts were detected in each patient, patients were divided into 3 groups. Group A injected with intralesional Candida antigen. Group B with intralesional MMR vaccine. Group C were treated with topical 25% podophyllin. Patients received a session every 2 weeks for 3 treatment sessions. With regard to the reduction in size and number of all warts, the best response was obtained in Candida antigen group where 46.7% showed complete clearance and 40% showed partial response followed by MMR group and the last was the podophyllin group, with no significant difference between them. Complete clearance of mother warts was noticed in 86.7% of Candida group, 53.3% in MMR group, and last 40% in podophyllin group, with a significantly better response in the Candida group (P = .027). Both intralesional Candida antigen and MMR vaccine are simple, safe, and effective treatment options with comparable results and better response than topical podophyllin.

Evaluation of the therapeutic efficacy of topical 50% hydrogen peroxide vs. 100% trichloroacetic acid vs. 5% 5-fluorouracil in the treatment of warts

ABSTRACT Background: Warts (verruca) are caused by human papilloma virus (HPV), which is known to affect the skin and mucosae. Over two hundred strains of HPV have been identified to date, among which few strains cause cutaneous lesions. Various treatment modalities have been elucidated in treating verruca lesions, yet the best therapeutic option is yet to be determined. Objectives: To evaluate the efficacy and safety of topical 50% hydrogen peroxide (H2O2), 100% trichloroacetic acid (TCA), and 5% 5-fluorouracil (5-FU) as a topical application in the treatment of warts. Methods: This was a prospective, interventional, clinical trial that included sixty patients with warts randomly allotted into three groups. Group A and group B were treated every week with topical 50% H2O2 and 100% TCA, respectively, and group C with 5% 5-FU under tape occlusion twice a day. The treatment was executed for a maximum period of eight weeks. The patients were evaluated with the Physician Wart Assessment (PWA) every two weeks of treatment and at three months after treatment completion. Results: At the end of the eight weeks of treatment, 13 patients (65%) in the H2O2 group, 11 patients (55%) in the TCA group, and 8 patients (40%) in the 5% 5-FU group displayed complete clearance of warts (PWA grade 0). In our study, side effects were significantly higher in the TCA group (70%) and in the 5% 5-FU group (60%), notably lower in the H2O2 group (30%) (p = 0.011). The most frequent side effect was irritation (25%), which was reported in all groups. No relapse was encountered at three months of treatment completion. Conclusion: According to our study, H2O2 and TCA have the advantage of earlier action over 5% 5-FU. However, H2O2 remarkably stands as a safer therapeutic option concerning the clearance of lesions, patient tolerability, and side effects. Key words: Warts, H2O2, TCA, 5%, 5-FU

Cidofovir in the Management of Non-Genital Warts: A Review.

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. We examined the literature on the use of cidofovir in the treatment of non-genital warts to further assess its safety and efficacy.  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.  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.  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  doi:10.36849/JDD.7258.

Intralesional immunotherapy with Bacille Calmette- Guerin (BCG) vaccine for the treatment of cutaneous warts

Myriad of therapeutic modalities for warts are available but none promises complete response. Despite adequate treatment, the virus may persist in the surrounding tissues leading to recurrence. Immunotherapy is considered better than destructive options where there are multiple lesions, extensive involvement and is best suitable for paediatric patients. The aim of the study was to evaluate the efficacy and safety of intralesional BCG vaccine in the management of cutaneous warts (common warts, plantar and periungual warts). Patients of age 12 years and above clinically diagnosed with cutaneous warts and presenting consecutively in the outdoor clinic of Dermatology, Venereology & Leprosy Department of Dr. R.P. Govt. Medical College, Kangra at Tanda, Himachal Pradesh between June 2021 to May 2022 were enrolled. BCG vaccine was administered into the largest wart intralesionally and the injection was repeated every 3 weeks for a maximum of four injections or till the complete clearance of warts, whichever was earlier. The efficacy was assessed every 3 weeks and patients were followed up at 3 and 6 months. Majority of patients were in the age group of 14-53 years. The study showed therapeutic response in 35.08% (20/57) patients and partial response in 63.15% (36/57) patients while there was no response in 1.75% (1/57) patients at the end of 12 weeks with a very low recurrence rate (5.2%). Plantar warts have responded excellently showing complete clearance in 91.5% and partial response in 9.5% of the patients followed by palmar warts achieving complete response in 60% and partial response in 40% of the patients. The reconstituted BCG immunotherapy is a cheap, effective and easily available therapeutic option which can easily be practised routinely. However, due its considerable adverse effects as compared to other immunotherapeutic agents, we do not recommend it to be the first line agent.

Clinical observation of laser combined with 5-aminolevulinic acid photodynamic therapy for female vulva condyloma acuminatum.

Condylomata acuminata, or genital warts (GW), are exceedingly prevalent, with human papilloma virus infection accounting for 90% of cases. It can be treated in a variety of methods, but the high recurrence rate and cervical scars make it difficult to choose the best treatment option. Hence, the study aims to find the effect of laser combined with 5-aminolevulinic acid (ALA) photodynamic therapy for condyloma acuminata in the vulva, vagina, and cervix. A total of 106 female patients with GW of the vulva, vagina, and cervical condyloma acuminata were treated in the Dermatology Department of Subei People's Hospital in Yangzhou from May 2020 to July 2021. All these patients were treated with laser combined with 5-ALA photodynamic therapy to observe the therapeutic effect. About 84.9% of patients responded to the first session of ALA-photodynamic treatment. Five patients relapsed in the 2nd week, two patients relapsed in the 4th week, one relapsed in the 8th week, one relapsed in the 12th week, and the relapsed patients were given 1-3 times of photodynamic therapy again, and no recurrence was seen in the 24th week. After four courses of treatment in 106 patients, the wart clearance rate was 100%. Laser combined with 5-ALA photodynamic therapy for female vulva, vagina, and cervix condyloma acuminata has a reliable curative effect, low recurrence rate, few adverse reactions, and less pain. It is worth promoting in female vulva, vagina, and cervical condyloma acuminata.

Comparison of Topical Adapalene and Electrocautery in Treatment of Plane Warts

Background: Warts are lesions that grow on the human skin due to infection named human papilloma-virus (HPV) type 1, 2, and 4. More than 100 types of HPV virus have been identified now. Aim: To compare the efficacy of adapalene and electrocautery therapies in managing plane warts. Study design: Randomized Control Trial. Methodology: A total of 52 patients via non probability consecutive sampling technique with plane warts were enrolled and randomly divided into 2 equal groups. The patients of Group A were treated with 0.5% Adapalene gel (applied twice daily over the lesions for maximum 3 months or until resolution of warts) and patients in group B were treated with electro-cautery procedure fortnightly for maximum 3 months or until resolution of warts). Patients were assessed after every 2 weeks for initial 3 months and then these patients were followed monthly for another 3 months and final outcome was seen at 6 months. Data was evaluated by using SPSS version 23. Student-t test was applied with p-value than 0.05 taken as significant. Results: The mean duration of wart resolution was observed as 45.92±19.22 days in the adapalene group, while the electro-cautery procedure took 45 ± 17.81 days for wart clearance. There were no statistically significant differences in the complications between the two groups (p=0.60). Practical Implication: Although successful outcomes have been achieved in many studies by using Adapalene and electrocautery separately for treating warts but none of the published research compares these two treatment modalities (Adapalene vs electrocautery) for treatment of plane warts as per our knowledge. Therefore to fill this gap, this study was designed to compare the efficacy of adapalene and electrocautery therapies. Conclusion: It was concluded that Both Adapalene and electrocautery are effective in treatment of plane warts and there are no statistically significant differences in the complications/side effects of these two treatment modalities. Keywords: Adapalene Gel 0.1%, Electrocautery, Plane Warts, Clinical Outcomes and Effectiveness.

Reprint of: Clearance of multiple cutaneous warts by targeting a single lesion: A randomized comparative evaluation of mild local hyperthermia versus cryotherapy

Reprint of: Clearance of multiple cutaneous warts by targeting a single lesion: A randomized comparative evaluation of mild local hyperthermia versus cryotherapy

A prospective randomized controlled study of Mycobacterium Indicus Pranii vaccine, Measles Mumps Rubella vaccine and Vitamin D3 in extragenital cutaneous warts.

Interventional, prospective, four arm randomized control. Outpatient department, Department of Dermatology, Venereology and Leprology, AIIMS Jodhpur (Rajasthan), India. Two hundred patients. The intervention administered in the groups were normal saline (A), vitamin D3 (B), MIP (C), and MMR (D). The injections were given into the largest wart at 2-weekly intervals until complete clearance or for a maximum of seven sittings. Post-treatment clearance of the injected wart and the distant wart was compared on the basis of change in wart number, percentage clearance, and mean time to complete clearance. Side effects were recorded. A total of 197 patients were recruited. The mean percentage improvement in the injected and non-injected warts was 68.4% and 66.8%, respectively. Intention to treat analysis (ITT) showed that complete clearance of lesions in injected wart occurred in placebo, vit D3 , MMR, and MIP arms in 64%, 66%, 58%, and 55% patients, respectively (p > 0.05), while in the non-injected warts in 62%, 64%, 52%, and 53%, respectively (p > 0.05). The mean time to achieve complete clearance of wart was fastest in MIP at 7.1 weeks followed by MMR at 7.2 weeks, VIT D3 at 7.4 weeks and in placebo group 7.8 weeks (p > 0.05). Side effects noted were fever, pain, erythema, and swelling which was highest in VIT D3 group (p < 0.05). The efficacy of immunotherapies was comparable to placebo with minimal side effects.

Intralesional measles-mumps-rubella vaccine in recurrent common warts: A placebo-controlled study

Background: Cutaneous warts cause immense an burden to patients as well as physicians. Although most resolve spontaneously within two years, treatment is sought for pain alleviating and cosmetic reasons. Various modalities of treatment are known. The destructive methods are unsuitable for multiple warts and are associated with chances of recurrence, scarring, and pain. In contrast, immunotherapy boosts the host immune response against the virus and helps in clearance, even in distant warts, without scars or physical change. This study was undertaken to assess the efficacy of intralesional MMR vaccine in multiple recurrent common warts. Materials and Methods: Sixty-six patients with recurrent common warts were divided equally into two groups. In group one, 0.5 mL of the MMR vaccine and, in group two, 0.5 mL of normal saline were injected intralesionally into the base of the largest wart. The sessions were repeated once in two weeks for a maximum of four sessions. The patients were followed up for twelve months to detect recurrences. Results: Complete clearance of warts was noted in 75.76% (n = 25) of the patients in the study group, whereas, in the control group, 78.79% (n = 26) patients showed no response. The result was statistically significant (p &lt; 0.01). Conclusion: Intralesional MMR is a safe and effective treatment option for recurrent common warts with minimal side effects. Key words: viral warts; intralesional MMR vaccine; immunotherapy

A Study of Comparison and Evaluation of Various Intralesional Therapies in Cutaneous Warts.

The study compares the efficacy of four immunotherapeutic agents, measles mumps and rubella (MMR), purified protein derivative (PPD), Candida extract, and vitamin D3, in the treatment of multiple cutaneous warts. To observe the clinical responses and safety of different intralesional immunotherapeutic agents and compare their efficacy. Hundred patients with multiple (>5) cutaneous warts were enrolled in the study and randomized into four groups: Group A: MMR, Group B: PPD, Group C: Candida extract, and Group D: Vitamin D. Target wart was selected, and the intralesional injections were given at three weekly intervals for a maximum of three doses. Response was observed in target and distant warts three months after the last injection. Intralesional vitamin D3 had the highest efficacy, while MMR had the lowest efficacy in clearance of target wart. Intralesional Candida extract had the highest efficacy, while vitamin D3 had the lowest efficacy in clearance of distant warts. Intralesional Candida extract was the most effective treatment for both local and distant warts. Side effects were minimal and transitory in nature. Intralesional immunotherapy is a safe, affordable, and efficacious treatment for warts.

Comparison of Cryotherapy and Topical Salicylic Acid in Common Warts: A Systematic Review and Meta‐Analysis

Background. Common warts are most common complaint among children and adults caused by human papillomavirus (HPV). Cryotherapy and topical salicylic acid are common therapies. Objective. To compare the efficacy and safety of cryotherapy and topical salicylic acid in common warts. Methods. Randomized controlled trials (RCTs) comparing cryotherapy and topical salicylic acid treatment in patients with common warts were searched by using PubMed, Embase, Google Scholar, and Cochrane Database of Systematic Reviews up to Oct 20, 2021. The keywords were “common warts/verruca,” “cryotherapy,” and “salicylic acid.” The language was restrained to English. No age or gender limitation was conducted. The outcomes were complete remission of all warts at different observation times, recurrence rates, and side effects. Study‐specific effect sizes were pooled by using the fixed‐effects model and the Mantel–Haenszel method. I2 was used to assess heterogeneity of studies. Results. Seven articles involving 976 patients randomized into the cryotherapy group or salicylic acid group were included. Of whom, 487 patients received cryotherapy, while 489 received salicylic acid treatment. With the fixed‐effects model, the pool effect of complete clearance of warts at 12 weeks comparing cryotherapy and salicylic acid was not statistically significant (RR = 0.99 (0.84–1.17), I2 = 0%). Conclusion. Comparable efficacy of cryotherapy and topical salicylic acid was conducted in common wart treatment. More high‐quality pieces of evidence with more samples are needed to confirm the results for further recommendations.

Efficacy and Safety of Intralesional Vitamin D3 in the Treatment of Plantar Warts

&#x0D; Objective: To explore the effectiveness and safety of intralesional cholecalciferol (vitamin D3) for the treatment of plantar warts.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Tertiary Care Hospital, Multan Pakistan, from Sep 2019 to Aug 2020.&#x0D; Methodology: Sixty-two patients with warts of varying sizes and duration were included in the study. Intralesional lignocaine was used to anaesthetize the skin. About 0.2ml injection of cholecalciferol (vitamin D3) solution (600,000 IU, 15mg/mL) was injected with a 30-gauge needle to the base of the wart under aseptic measures. A maximum of 4 warts were injected per session at 3-week intervals until resolution or for amaximum of 6 treatments. Patients were followed up for six months after the last injection for recurrence.&#x0D; Results: Sixty-two patients completed the study, including 45(72.58%), patients who had complete clearance of warts following injection 14(22.5%) which showed partial response and 3(4%) cases had no response.&#x0D; Conclusions: Intralesional vitamin D3 is a safe and effective treatment for plantar warts.

Complete clearance of periungual warts in an immunocompromised patient using diluted intralesional bleomycin.

Periungual warts are commonly resistant to treatment, especially in immunocompromised patients. Many treatment modalities have been used with variable results. Bleomycin is one of the most effective treatments for recalcitrant warts, including the periungual type. It can be used either as a topical application after needling or as a direct injection. We report complete clearance of multiple periungual warts in an immunocompromised patient after diluted bleomycin injection. The patient did not have a recurrence after eight months of follow up.

Immunothrombotic Mechanisms Induced by Ingenol Mebutate Lead to Rapid Necrosis and Clearance of Anogenital Warts.

Ingenol mebutate (IM) is highly effective in the treatment of human papillomavirus (HPV)-induced anogenital warts (AGW) leading to fast ablation within hours. However, the exact mode of action is still largely unknown. We performed dermoscopy, in vivo confocal microscopy (CLM), histology, immunohistochemistry, and immunofluorescence to gain insights in mechanisms of IM treatment in AGW. In addition, we used in vitro assays (ELISA, HPV-transfection models) to further investigate in vivo findings. IM treatment leads to a strong recruitment of neutrophils with thrombosis of small skin vessels within 8 h, in a sense of immunothrombosis. In vivo and in vitro analyses showed that IM supports a prothrombotic environment by endothelial cell activation and von Willebrand factor (VWF) secretion, in addition to induction of neutrophil extracellular traps (NETosis). IM superinduces CXCL8/IL-8 expression in HPV-E6/E7 transfected HaCaT cells when compared to non-infected keratinocytes. Rapid ablation of warts after IM treatment can be well explained by the observed immunothrombosis. This new mechanism has so far only been observed in HPV-induced lesions and is completely different from the mechanisms we see in the treatment of transformed keratinocytes in actinic keratosis. Our initial findings indicate an HPV-specific effect, which could be also of interest for the treatment of other HPV-induced lesions. Larger studies are now needed to further investigate the potential of IM in different HPV tumors.

A large case series on the use of diphencyprone immunotherapy in the clearance of palmoplantar warts.

Palmoplantar viral warts are common, often affecting the quality of life of patients and present a major therapeutic challenge. Immunotherapy using diphencyprone (DCP) can be beneficial especially if first-line treatments fail. To determine the effectiveness of DCP in clearing viral warts, and to provide detail on the number of treatments required and any adverse effects (AEs). This was a retrospective case series of 124 patients who had received DCP treatment in a UK private practice setting from 1991 to 2008, carried out by a dermatologist experienced in the procedure. All patients had been referred by other clinicians after failure of standard treatments. The study data were extracted from clinical records, with follow-up until wart clearance or treatment discontinuation. There was an equal distribution in sexes (63 females, 61 males), with 37% of patients having warts present for greater than 5 years. The majority (93%) of patients had already tried cryotherapy, which was unsuccessful in clearing warts completely in all cases. Following DCP treatment, 77% of patients achieved full eradication of their warts, including three patients who were immunosuppressed. The mean number of DCP treatments required to achieve full clearance was 4·7, and the mean concentration of DCP required was 4%. Only 12% of patients experienced AEs, which were mild, and included urticaria and blistering. We suggest that DCP immunotherapy is a safe and effective treatment for eradicating viral warts, especially in recalcitrant cases.

The efficacy and safety of intralesional Candida vaccine versus topical diphencyproprobenone in immunotherapy of verruca vulgaris: A randomized comparative study

Various therapeutic options are available for verruca. While physical destruction may be associated with scarring, immunotherapy may be effective in treating warts through stimulating body immune response. The objective of the study was to compare the efficacy, safety, and outcome of Candida antigen vs diphencyprone (DPCP) in the treatment of warts. Fifty patients were randomly assigned to receive either intralesional Candida antigen every 3 weeks or weekly DPCP application. Both treatments were applied only to the mother wart. Lesions’ clearance and associated side effects were observed up to 4 weeks after treatment. Two blinded physicians evaluated photos of warts before and 4 weeks after the end of treatment. Both modalities granted wart clearance and/or improvement with no statistically significant difference; however, Candida antigen was significantly better in clearing adjacent untreated warts (p = 0.046). Fewer side effects were observed among the Candida antigen group. The response was duration associated in the Candida groups only. Intralesional Candida antigen injection and DPCP treatments for warts yielded improvement with superiority of Candida injection in eradicating distant lesions and fewer side effects. A shorter wart duration may be associated with a better therapeutic response with Candida antigen.

ALA-PDT combined with oral acitretin in the treatment of refractory condyloma acuminatum in anal canal

BackgroundCondyloma acuminatum (CA) of the anal canal is difficult to treat and subject to relapse.. We investigated the effects of aminolevulinic acid-based photodynamic therapy (ALA-PDT) combined with oral acitretin during therapy of refractory CA in the anal canal. We also conducted a clinical retrospective study for the treatment of intra-anal CA. MethodsA total of 101 patients diagnosed with intra-anal CA were enrolled. All patients underwent liquid nitrogen cryotherapy as a basic treatment until visible wart clearance. Patients were divided into two groups depending on the treatment modality after cryotherapy. ALA-PDT group with 51 patients was given ALA-PDT treatment, and ALA-PDT plus acitretin group with 50 patients was given ALA-PDT treatment combined with oral acitretin. The cure rate, recurrence rate, and adverse reactions of the two groups were analyzed and recorded. ResultsThe cure rate in the ALA-PDT plus acitretin group was 94% (47/50), which was significantly higher than 80.4% (41/51) in ALA-PDT group. The recurrence rate in the ALA-PDT plus acitretin group was 6% (3/50), which was lower than 19.6% (10/51) in ALA-PDT group (P<0.05). ConclusionALA-PDT combined with oral acitretin is effective and safe in the treatment of refractory CA in anal canal, and with further study may become an option for these patients.

Intralesional full‐concentration (25 mg/ml) methotrexate in the treatment of plantar warts: A pilot study

Plantar warts continue to represent a therapeutic challenge due to treatment resistance and high recurrence rates. Intralesional methotrexate, a cytotoxic chemotherapeutic agent with in-vitro anti-viral properties has been used for many dermatological indications. Two previous studies evaluated intralesional injection of diluted methotrexate (in 0.5, 1, and 2 mg/ml dilutions) in the treatment of warts and found it poorly effective. The concentrations used in these studies were much lower than those used for other indications. The current, open-label, prospective, pilot study aimed to evaluate the safety and efficacy of the intralesional injection of full concentration (25 mg/ml) methotrexate in the treatment of plantar warts. Twenty patients with plantar warts, 10 (50%) males, and 10 (50%) females, with mean ± SD age of 28.45 ± 8.66 years (range, 18-46 years) received biweekly sessions of intralesional methotrexate (25 mg/ml) until complete clearance or for a maximum of 6 sessions. Complete clearance of warts was achieved in 2 (10%), 6 (30%), and 7 (35%) patients after 4, 5, and 6 sessions, respectively. Another 8 (40%) patients showed partial improvement after 6 sessions. The response rate did not correlate significantly with the number of warts. Nine (45%) patients did not report any side effects. Pain and bruises were reported by 8 (40%) and 6 (30%) patients, respectively. These findings suggest that biweekly sessions of full (25 mg/ml) concentration of methotrexate are a safe and effective treatment for plantar warts. It may be considered an alternative line of treatment for resistant cases.