Warts Research Articles

Pediatric genital warts successfully treated with photodynamic therapy

Genital warts (GWs) are the most common sexually transmitted infections worldwide, caused by the human papillomavirus (HPV). In adults, the primary mode of transmission is through sexual contact, whereas in children it can occur through skin-to-skin or skin-to-mucosa contact and be sexual or non-sexual. The increasing prevalence of GWs in children has renewed the interest in therapeutic management which still presents a unique challenge, being influenced by many variables including size, quantity, and location of warts, as well as the presence of comorbidities. Photodynamic therapy (PDT) has already shown encouraging results in treating viral warts in adult patients, but its use is still not standardized in the pediatric population. On this topic, we report the case of an otherwise healthy 5-year-old child affected by GWs, successfully treated with three sessions of PDT with 10% 5-aminolaevulinic acid (ALA), at one-month intervals. Our case is paradigmatic of the potentiality of PDT to treat difficult lesions in a pediatric setting.

Investigation of the Efficacy of Nowarta110 in the Treatment of HPV-16 and HPV-18 Oncogenically-transformed Human Cells and Cancer-implanted Animal Models.

Cervical cancer is the third leading cause of cancer-related death in women worldwide. Nearly all cases of cervical cancer are due to infection with human papillomavirus (HPV). Nowata110 has shown breakthrough therapeutic efficacy in phase II clinical study against plantar warts, with no reported side effects. This study evaluated the effectiveness of Nowarta110 in killing cultured HPV-transformed cancer cells and its anti-cancer effects in mice, using both vaginally engrafted and subcutaneously implanted animal cancer models. Nowata110 is a novel compound composed of colloidal silver and fig extract. The cytotoxic properties of Nowarta110 were evaluated on HPV-16 and HPV-18-transformed human cancer cells (ARPE-19/HPV-16 and HeLa cells, respectively). The therapeutic potential of Nowarta110 in vivo was evaluated following the engraftment of ME-180 epidermoid carcinoma cells in the mouse vagina or their subcutaneous implantation. Nowarta110 treatment was initiated when the tumor reached an approximate volume of 65 mm3 Results: Our data showed that HPV16-expressing human retinal pigmented epithelial cells are susceptible to Nowarta110-induced cell death, with a reduction in cell viability observed at 1% Nowarta110 and a complete absence of viable cells at 5% Nowarta110. In HPV18-expressing HeLa cells, Nowarta110 caused significant and rapid cell death at a dose of 5%, whereas lower doses of 1% did not produce the same effects. The results from animal studies indicated that Nowarta110 effectively induced tumor regression in both the intravaginal and subcutaneous tumor models. Nowarta110 effectively induced cell death in HPV-16 and HPV-18-transformed human cancer cells. It also effectively induced tumor regression in mouse models with intravaginally engrafted or subcutaneously implanted cancer cells. Considering the high prevalence of HPV-induced cervical dysplasia and cancer and the lack of treatment, clinical studies to promote the implementation of Nowarta110 are warranted.

Application of Photodynamic Therapy with 5-Aminolevulinic Acid and Fractional CO2 Laser for the Management of Recalcitrant Plantar Warts

Application of Photodynamic Therapy with 5-Aminolevulinic Acid and Fractional CO2 Laser for the Management of Recalcitrant Plantar Warts

Overview of the human papilloma virus: types and its treatment

The human papillomavirus (HPV) is the most prevalent sexually transmitted disease in the United States and one of the most common causes of sexually transmitted infections (STDs) globally. Warts are cutaneous and occasionally mucous lesions brought on by HPV, with 2-20% of elementary school students getting them. There are three types of warts: non-genital warts, flat warts, and plantar warts. Non-genital warts are hyperkeratotic, exophytic, dome-shaped papules or plaques commonly associated with HPV-1, 2, 4, 27, or 57. Flat warts appear as flesh-coloured, erythematous to brown, or hyperpigmented smooth papules with a flat top and a diameter of 2 to 5 mm. Plantar warts, also known as verrucae plantaris, are cutaneous lesions on the plantar aspect of the foot that result from a human papillomavirus infection of keratinocytes (HPV).Genital warts are transmitted through sexual contact, while autoinoculation and vertical transfer do occasionally happen. After engaging in sexual activity with an infected partner, about 70% of people experience anogenital warts. Treatment for HPV includes imiquimod cream formulations, photodynamic treatment (PDT), green tea, chemical cautery, fluorouracil cream, cryotherapy, and surgical treatment. Common warts are hyperkeratotic, exophytic, dome-shaped papules or plaques commonly found in fingers, dorsal surfaces of hands, knees, or elbows. Flat warts are flesh-coloured, erythematous to brown, or hyperpigmented smooth papules with a flat top and a diameter of 2 to 5 mm. Plantar warts are unique in their location and appearance, primarily affecting high-pressure locations on the palms and soles and are uniquely linked to HPV type 1.

Effects of the COVID-19 pandemic on inpatient dermatosurgery in Germany : Retrospective evaluation of the surgical cases from nine dermatology clinics

Currently, only little data is available on the impact of the COVID-19 pandemic on inpatient dermatosurgical care in German dermatological clinics. Aretrospective analysis of all dermatosurgical cases that were treated in inpatient setting in nine German dermatological clinics in four federal states in 2019, 2020 and 2021 was performed. The diagnoses were recorded using the ICD-10codes. In addition, demographic data such as age, gender and the length of inpatient stay were analysed. In 2019, 2020 and 2021, a total of 10,739, 9185 and 9828 dermatosurgical inpatients were treated respectively. Thus, the reduction of inpatient dermatosurgical cases was 14.5% in 2020 and 8.5% in 2021 compared to 2019. Inpatient surgical treatment of melanoma decreased by 10.1% of cases in 2020. This decrease was only 1.4% in 2021 compared to 2019. The number of inpatient surgeries performed for benign lesions such as melanocytic nevi or viral warts reduced sharply in both pandemic years. Our data show for the first time how inpatient care for the entire spectrum of dermatosurgical diseases developed during the COVID-19 pandemic in Germany. After the initial marked decline in inpatient dermatosurgical cases in 2020, there was less difference in 2021 compared to 2019. This trend can be interpreted as an indication that there is still astrong need for inpatient dermatosurgical care that cannot yet be met on an outpatient basis.

Conventional versus daylight photodynamic therapy for recalcitrant hand warts: Efficacy, safety and recurrence

BackgroundAcral 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. Objectivesto 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 methods68 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. Results48 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. ConclusionPDT 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.

Detection of human papillomavirus in plantar warts and its impact on outcome.

Cutaneous warts are caused by human papillomavirus (HPV) infection. Distinguishing plantar warts from clavus and tylosis can be difficult. A less-invasive method of examining these lesions is necessary. Previously, we collected data on 90 patients with warts and related diseases to explore differentiation methods using HPV typing of tissue from the wart surface. In that study, 21 patients were diagnosed as cases with plantar warts, however, 10 of those 21 cases showed HPV-negative by polymerase chain reaction analysis, causing some ambiguity, thus their outcomes should be confirmed. To assess the role of HPV typing in clinical practice, we followed up these 21 cases (11 HPV-positive and 10 HPV-negative) and analyzed their outcomes. The HPV-positive group included HPV1a (one case), HPV27 (four cases), HPV57 (three cases), and HPV65 (three cases). The median age of the 21 patients was 43 years, that of the 11 HPV-positive cases was 37 years, and that of the 10 HPV-negative cases was 44 years. The sex ratios (male:female) of the HPV-positive and HPV-negative groups were 6:5 and 2:8, respectively. All 21 patients were treated with liquid nitrogen after surface keratin removal, concomitant with salicylic acid topical plaster or oral administration of Yokuinin. The longest follow-up period was 548 days. Kaplan-Meier analysis was performed to assess the healing rate according to HPV-positivity. The healing rate in HPV-positive cases was significantly higher than in HPV-negative cases (P = 0.001). Although the sample size was small, the results suggest HPV typing using non-invasive surface materials facilitates accurate diagnosis and prevents prolonged treatment of plantar warts.

Clinical cases of verruciform epidermodysplasia of Lewandovski—Luts

Data from the medical literature and own observations of veruciform epidermodysplasia of Lewandovski — Luts (VEDLL) indicate that there are many issues that need to be resolved or clarified. They relate, in particular, to carrying out genetic research — in order to prove the phenomenon and regularities of heredity of dermatosis. The detection of a benign neoplastic formation in one of our patients — esophageal leiomyoma — obliges doctors to carefully examine patients with VEDLL, even without complaints about disorders of one or another body system. Does such a case not suggest the possibility of neoplastic transformation of a benign nature and not only from the side of the skin (papillomas and warts)? Can HPV for VEDLL cause, in addition to skin carcinoma, the occurrence of internal organ tumors? An important task of dermatologists is the early detection of patients among children, who often have common forms of wart-like efflorescences. It can be assumed that in some patients, the disease is latent for some time and manifests itself only under the influence of adverse factors (inadequate insolation, stress, etc.). The issues of VEDLL require practicing dermatovenereologists not only to conduct clinical and differential diagnosis of wart-like dermatoses but also to carry out laboratory tests to identify dermatosis (biopsy, cytology, PCR), which will allow for more frequent detection of VDLL. Since the rarity of VEDLL does not contribute to the accumulation of a sufficient amount of results on the detection of pathogenetic factors of dermatosis, particularly immunological ones, the treatment problem remains relevant. It is necessary to conduct permanent monitoring of the development of VEDLL to identify early signs of neoplastic transformation and determine predictors, that is, prognostic parameters, and introduce methods for their determination.

Variable clinical presentation of hypomorphic DCLRE1C deficiency from childhood to adulthood.

In this study, we aimed to report long-term follow-up of our pediatric and adult patients with DCLRE1C (DNA cross-link repair 1C) hypomorphic mutation who were diagnosed leaky severe combined immunodeficiency (SCID). Eighteen patients (13 children and five adults), aged between 6 and 29 years were included. Clinical and immunological features, including immunoglobulin levels, T and B cells, natural killer cell subsets, regulator T (Treg) cell ratios/markers, and cytokines, were assessed before and after hematopoietic stem cell transplantation (HSCT) and compared with healthy controls. Recurrent infections (78%) and skin manifestations (61%) such as granulomatous skin lesions, warts, and vitiligo were the most common clinical findings. Autoimmune diseases were observed in 33% and malignancy in 17%. Most patients had low serum IgA and B- and T-cell lymphopenia at the first admission. Recent thymic emigrants (RTE), Tnaive, Bnaive, CD56dimCD16+ cell ratios were significantly lower in the patients than in control; however, follicular helper T TFH and Th1 [interferon gamma (IFN-γ)] cell ratios were significantly higher than the control. Although, Treg ratio and its functional receptors tend to be high but not significant. Eleven patients (61.1%) were treated with HSCT. Median follow-up times of transplant patients was 56 (9-67) months. Patients with hypomorphic DCLRE1C mutations may present with variable clinical and laboratory findings at different ages. Our study showed a helper T (Th)1-dominant immune response before and after HSCT. Increased IFN-γ and TFH cells ratio could be a reason of chronic inflammation and autoimmunity developing before and after HSCT. Long-term follow-up of these patients after HSCT will help to better understand the disease and its pathophysiology.

Epidemiological Characteristics of Patients with Plantar Warts: a Single-center Retrospective Study

Background: Plantar wart is a common dermatologic disease encountered in outpatient clinics. Clinical trials for the treatment of plantar warts have been conducted, but only a few studies have focused on the epidemiological factors of plantar warts. Objective: This study aims to analyze the epidemiological factors for plantar warts in Korean individuals at a single institution. Methods: We retrospectively reviewed the electronic medical records of patients with plantar warts at Chosun University Hospital from January 2019 to December 2022. Results: A total of 176 patients were included in this retrospective study. Plantar warts are more common in younger ages, and men tend to have higher rates of plantar warts than women (M:F = 3:1). The patients showed a higher incidence of plantar warts during winter (29.0%), of which 74.4% were urban residents. 6.3% of patients had warts after trauma. Plantar warts were also observed in 66 of the 504 household members of the patients. The most common locations of wart lesions were in the forefoot (73.3%), followed by the toes (60.8%), midfoot (22.2%), and heel (18.2%). Moreover, the location of the lesions was almost equal, most often on the right side (34.7%), followed by the bilateral (33.5%) and left sides (31.8%). Conclusion: This study offers valuable information about the epidemiological factors of plantar warts in South Korea. These contents will be used for lifestyle education to prevent the recurrence of plantar warts.

A Hidden Lake on a Mountain Basal Cell Carcinoma Arising within Verruca Vulgaris in an Uncommon Region

A Hidden Lake on a Mountain Basal Cell Carcinoma Arising within Verruca Vulgaris in an Uncommon Region

Congenital ichthyosis is associated with cutaneous infections in a case-control study of 2260 patients.

Evidence of congenital icthyosis association with cutaneous infections is limited to case reports. We conducted a nested case-control study assessing congenital ichthyosis associations with cutaneous infections using a large national database. Congenital ichthyosis patients vs. controls had higher odds of onychomycosis, tinea corporis, verruca vulgaris, and tinea pedis.

A pilot study on the efficacy of 10600 nm carbon dioxide laser ablation in treatment of eyelid margin lesions

Objectives: Eyelid margin lesions cause discomfort by impeding both central and peripheral vision, depending on their position on the eyelids, thus hindering everyday routines. However, surgical excision, radiofrequency, electrocautery, and cryosurgery are employed for treatment, although they are complicated and have functional limitations. Carbon dioxide (CO2) lasers were used to assess the efficacy, safety, and patient satisfaction with CO2 laser ablation in managing eyelid margin lesions. Material and Methods: This is a pilot study of patients with eyelid margin lesions presented to a private clinic in urban Gujarat between June 2020 and June 2023. All patients were treated with a 10600 nm CO2 laser with a power of 1–2 W in continuous mode. The eyelid lesions were classified into three categories based on their size: Small (1–3 mm), medium (4–6 mm), and large (7–10 mm). The clinical response was assessed by the treating physician at week 1 and week 4, and categorized as excellent (complete clearance of lesion), moderate (&gt;50%), or poor (&lt;50%). Patients were asked to rate their level of satisfaction on a three-point scale at the end of the follow-up period: Dissatisfied, somewhat satisfied, or very satisfied. Results: Ten patients of all females with six of them having compound melanocytic nevi, two of them each had cystic hidradenoma, and one each had cyst of zeis and verruca vulgaris. Six of them had small lesions, two had medium, and two had large lesions. The clinical response grading of physicians at both 1 week and 4 weeks was excellent, and the patient satisfaction questionnaire yielded excellent outcomes. Conclusion: The ablative CO2 laser is an excellent device used for the treatment of eyelid margin lesions, particularly when performed by an expert and skilled dermatologist. The application of this treatment approach has proven to be very beneficial and shows excellent results in terms of both the esthetic appearance and structural function of the eyelids.

Photodynamic therapy in dermatology: established and new indications.

Photodynamic therapy (PDT) is internationally established as an approved treatment option for in situ forms of keratinocytic skin cancer (actinic keratoses, Bowen's disease, basal cell carcinoma). For these indications, there are standardized treatment protocols using narrow-spectrum light sources or (artificial) daylight, the use of which is associated with successful healing, a low rate of lesion recurrence, and a very good cosmetic result. Daylight PDT is superior to conventional PDT in terms of significantly less pain and associated higher patient acceptance. Newer indications, for which no approval has yet been granted, but which nevertheless have sufficient evidence of efficacy according to the study situation, are inflammatory (lichen sclerosus, acne) and infectious dermatoses (viral warts, cutaneous leishmaniasis, atypical mycobacteriosis). In addition, PDT is increasingly being used in aesthetic dermatology with the aim of skin rejuvenation.

Cantharidin (1%), podophyllin (5%), and salicylic acid (30%) formulation in recalcitrant plantar warts: Analysis of 48 patients.

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.

From thinning to disappearance: A case report on the healing pattern of multiple and giant plantar warts.

Plantar warts, caused by human papillomavirus (HPV) infection, are a common skin condition on the plantar surface. Despite the availability of various treatments, achieving satisfactory outcomes remains elusive. This study explores a novel therapeutic approach combining traditional Chinese medicine (TCM) soaking therapy with cryotherapy to address this challenge. This study focuses on 3 patients who presented with multiple and giant plantar warts, each with a disease duration exceeding 2 years. These patients had undergone numerous unsuccessful cryotherapy treatments, leaving them with persistent and troublesome warts. All 3 patients were diagnosed with multiple and giant plantar warts caused by HPV infection. Following unsuccessful cryotherapies, the patients were administered TCM soaking therapy as an adjunct treatment. Remarkably, all 3 patients achieved complete remission of their plantar warts within 2 to 4 months after combining cryotherapy with TCM soaking therapy. Our findings suggest that relying solely on cryotherapy is insufficient for effectively treating plantar warts. The key to successful treatment lies in inhibiting wart proliferation and continuously thinning them, which can be achieved through soaking in TCM. This study demonstrates the potential of combining cryotherapy with TCM soaking as a novel and effective therapeutic approach for treating multiple and giant plantar warts.

Burden of chronic skin disease from an Asian perspective: Assessment of health state utilities and quality of life in a Singapore cohort

BackgroundUnderstanding health state utilities of skin diseases is is essential for health economic evaluations in an era of rising healthcare costs. ObjectiveTo create a catalogue of utilities values of chronic skin diseases among Asians. MethodsThis is a cross-sectional study of adults attending a dermatology outpatient clinic from February 2019 to March 2023 with one of these skin diseases: 1) Eczema, 2) Psoriasis, 3) Acne vulgaris, 4) Chronic Urticaria, 5) Pigmentary disorders, 6) Hair Loss, 7) Viral warts, 8) Fungal infections and 9) Keloids. Demographic and socio-economic information were collected. . Health status and utilities (Dermatology Life Quality Index, Skindex-16, EQ-5D, Visual analogue scale, time-trade-off (TTO) and willingness-to-pay) were measured.. Results183 patients with a median age of 35.5 (21 to 77) years old were included. Majority (76.9%) were Chinese, followed by Malays (11.5%). TTO utilities were lower than EQ-5D utilities across all disease severity and most skin diseases. Patients were willing to pay USD$740 or more for a hypothetical drug to cure conditions such as psoriasis, acne, hairloss and keloids. LimitationsLimited sample size and ethnic representation. ConclusionsThis study provides a catalogue of utilities in skin diseases and highlights the strengths and challenges of different measures.

Treatment of Plantar Warts with a Nitric-Zinc Complex Solution: A Review of 72 Cases.

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. 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. A descriptive study was conducted involving 72 patients who exhibited symptoms of plantar warts. These patients underwent chemical treatment using a nitric-zinc complex. 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. 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.

Photogallery. Human papillomavirus infection of the skin and mucous membranes in people living with HIV

The human papillomavirus is ubiquitous. It is estimated that over a third of people with apparently healthy skin are carriers of human papillomavirus. HIV-associated immunodeficiency contributes to the manifestation of clinical symptoms of human papillomavirus infection. Against the background of severe (the number of CD4+ T-lymphocytes below 200 cells/μl) and pronounced (CD4+ T-lymphocytes from 200 to 349 cells/μl) immunodeficiency caused by HIV infection (human immunodeficiency virus), the period of persistence of human papillomavirus is longer, and the clinical picture and course of human papillomavirus infection can significantly differ compared to HIV-positive individuals with intact immunity and people without HIV. At the same time, formations on the skin and mucous membranes are often multiple and can be characterized by rapid growth, large size, location outside the typical localization, resistance to treatment, recurrent course, and lack of tendency to spontaneous regression. Taking antiretroviral drugs for the treatment of HIV infection has a generally beneficial effect on the clinical course and prognosis of viral warts; With regard to anogenital warts, the researchers’ conclusions are not so clear. A number of experts believe that viral-immunological control of HIV infection may not be sufficient to successfully combat venereal warts. The photogallery presents various clinical types of viral and anogenital (venereal) warts in people living with HIV. Each of them is assigned one of the variants of the stage of secondary diseases of HIV infection (4A, 4B or 4V according to its Russian clinical classification) depending on the severity of concomitant opportunistic diseases. In all clinical cases, with the exception of the last one, patients experienced severe or pronounced immunodeficiency and progression of HIV infection in the absence of antiretroviral therapy. In the last observation, giant Buschke–Levenstein condyloma developed with a slight immunodeficiency against the background of effective antiretroviral therapy.

Association of vitamin D with risk of warts: A retrospective and Mendelian randomization study.

The clinical strategy of oral supplementation of Vitamin D (VD) as a preventive and therapeutic measure for warts needs further exploration. The clinical data of patients with skin diseases who visited the Children's Hospital affiliated with Chongqing Medical University from February 2018 to June 2024 were collected. The serum VD levels in patients with warts (common warts, flat warts, and plantar warts) and patients with other common skin diseases (atopic dermatitis, psoriasis, alopecia areata, vitiligo, and chronic urticaria) were compared. Two-sample bidirectional Mendelian randomization (MR) analysis was performed to investigate potential causal associations between VD and warts. The average serum VD level of children with warts was 23.27±7.07ng/mL, which showed no statistically significant difference compared to children with other common skin diseases. The inverse variance weighted (IVW) method analysis indicated a positive causal relationship between VD and warts (Odds Ratio [OR]=1.86, [95% CI: 1.19-2.92], p=0.007). Sensitivity analysis did not show any indication of horizontal pleiotropy or heterogeneity. The MR-PRESSO method did not identify any outliers. The levels of serum VD in children with warts do not significantly decrease compared to children with other common skin conditions. The evidence from the MR analysis indicates a positive causal relationship between VD and warts, suggesting caution in supplementing VD for children with warts who have normal or elevated serum VD levels. Further clinical studies are needed for validation in the future.