Skip to main content

Microwave therapy for cutaneous human papilloma virus infection



Human papilloma virus (HPV) infects keratinocytes of the skin and mucous membranes, and is associated with the induction of cutaneous warts and malignancy. Warts can induce significant morbidity and disability but most therapies, including cryotherapy, laser, and radiofrequency devices showlowefficacy and induce discomfort through tissue destruction. Microwaves are readily capable of passing through highly keratinised skin to deliver energy and induce heating of the tissue in a highly controllable, uniform manner.


To determine the effects of microwave on cutaneous HPV infection.

Materials & methods

We undertook a pilot study of microwave therapy to the skin in 32 consecutive individuals with 52 recalcitrant long-lived viral cutaneous warts. Additionally, we undertook a molecular characterisation of the effects of microwaves on the skin.


Tissue inflammation was minimal, but 75.9% of lesions cleared which compares favourably with previous studies showing a clearance rate of 23-33% for cryotherapy or salicylic acid. We show that microwaves specifically induce dendritic cell cross-presentation of HPV antigen to CD8+ T cells and suggest that IL-6 may be important for DC IRF1 and IRF4 modulation to enhance this process.


Keratinocyte-skin dendritic cell cross-talk is integral to host defence against HPV infections, and this pilot study supports the concept of microwave induction of anti-HPV immunity which offers a promising approach for treatment of HPV-induced viral warts and potentially HPV-related cancers.


  1. 1.

    Cockayne S, Hewitt C, Hicks K, et al. Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial. BMJ 2011; 342: d3271.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R. Topical treatments for cutaneous warts. Cochrane Database Syst Rev 2012; 9: CD001781.

    Google Scholar 

  3. 3.

    Riddel C, Rashid R, Thomas V. Ungual and periungual human papillomavirus-associated squamous cell carcinoma: a review. J Am Acad Dermatol 2011; 64: 1147–53.

    Article  PubMed  Google Scholar 

  4. 4.

    Stern PL. Immune control of human papillomavirus (HPV) associated anogenital disease and potential for vaccination. J Clin Virol 2005; 32: S72–81.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Soong RS, Song L, Trieu J, et al. Toll-like receptor agonist imiquimod facilitates antigen-specific CD8+ T-cell accumulation in the genital tract leading to tumor control through IFNgamma. Clin Cancer Res 2014; 20: 5456–67.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Edwards L, Ferenczy A, Eron L, et al. Self-administered topical 5% imiquimod cream for external anogenital warts. HPV Study Group. Human PapillomaVirus. Arch Dermatol 1998; 134: 25–30.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Bristow I, Walker N. Pulsed dye laser for the treatment of plantar warts-two case studies. Foot 1997; 7: 229–30.

    Article  Google Scholar 

  8. 8.

    Kimura U, Takeuchi K, Kinoshita A, Takamori K, Suga Y. Long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet laser treatment for refractory warts on hands and feet. J Dermatol 2014; 41: 252–7.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Park H, Choi W. Pulsed dye laser treatment for viral warts: a study of 120 patients. J Dermatol 2008; 35: 491–8.

    Article  PubMed  Google Scholar 

  10. 10.

    Tosti A, Piraccini BM. Warts of the nail unit: surgical and nonsurgical approaches. Dermatol Surg 2001; 27: 235–9.

    CAS  PubMed  Google Scholar 

  11. 11.

    Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. British Association of Dermatologists’ guidelines for the management of cutaneous warts 2014. Br J Dermatol 2014; 171: 696–712.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Kwok CS, Holland R, Gibbs S. Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials. Br J Dermatol 2011; 165: 233–46.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Lloyd DM, Lau KN, Welsh F, et al. International multicentre prospective study on microwave ablation of liver tumours: preliminary results. HPB (Oxford) 2011; 13: 579–85.

    Article  Google Scholar 

  14. 14.

    Polak ME, Thirdborough SM, Ung CY, et al. Distinct molecular signature of human skin Langerhans cells denotes critical differences in cutaneous dendritic cell immune regulation. J Invest Dermatol 2014; 134: 695–703.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Ressing ME, de Jong JH, Brandt RM, et al. Differential binding of viral peptides to HLA-A2 alleles. Implications for human papillomavirus type 16 E7 peptide-based vaccination against cervical carcinoma. Eur J Immunol 1999; 29: 1292–303.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Bruggink SC, Gussekloo J, Berger MY, et al. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial. CMAJ 2010; 182: 1624–30.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Emblation Medical Limited. Swift applicator instructions for use. Alloa, Scotland 2012.

    Google Scholar 

  18. 18.

    Karsai S, Daschlein G. Smoking guns”: Hazards generated by laser and electrocautery smoke. J Dtsch Dermatol Ges 2012; 10: 633–6.

    PubMed  Google Scholar 

  19. 19.

    Tan HH, Goh CL. Viral infections affecting the skin in organ transplant recipients: epidemiology and current management strategies. Am J Clin Dermatol 2006; 7: 13–29.

    Article  PubMed  Google Scholar 

  20. 20.

    de Jong A, O’Neill T, Khan AY, et al. Enhancement of human papillomavirus (HPV) type 16 E6 and E7-specific T-cell immunity in healthy volunteers through vaccination with TA-CIN, an HPV16 L2E7E6 fusion protein vaccine. Vaccine 2002; 20: 3456–64.

    Article  PubMed  Google Scholar 

  21. 21.

    Bottcher JP, Schanz O, Garbers C, et al. IL-6 trans-signalingdependent rapid development of cytotoxic CD8+ T cell function. Cell Rep 2014; 8: 1318–27.

    Article  PubMed  Google Scholar 

  22. 22.

    Schlitzer A, McGovern N, Teo P, et al. IRF4 transcription factordependent CD11b+ dendritic cells in human and mouse control mucosal IL-17 cytokine responses. Immunity 2013; 38: 970–83.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Vander Lugt B, Khan AA, Hackney JA, et al. Transcriptional programming of dendritic cells for enhanced MHC class II antigen presentation. Nat Immunol 2013; 15: 161–7.

    Article  Google Scholar 

  24. 24.

    Tussiwand R, Lee WL, Murphy TL, et al. Compensatory dendritic cell development mediated by BATF-IRF interactions. Nature 2012; 490: 502–7.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Huber M, Lohoff M. IRF4 at the crossroads of effector T-cell fate decision. Eur J Immunol 2014; 44: 1886–95.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Raczkowski F, Ritter J, Heesch K, et al. The transcription factor interferon regulatory factor 4 is required for the generation of protective effector CD8+ T cells. Proc Natl Acad Sci USA 2013; 110: 15019–24.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Park JS, Kim EJ, Kwon HJ, Hwang ES, Namkoong SE, Um SJ. Inactivation of interferon regulatory factor-1 tumor suppressor protein by HPV E7 oncoprotein. Implication for the E7-mediated immune evasion mechanism in cervical carcinogenesis. J Biol Chem 2000; 275: 6764–9.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Muto V, Stellacci E, Lamberti AG, et al. Human papillomavirus type 16 E5 protein induces expression of beta interferon through interferon regulatory factor 1 in human keratinocytes. J Virol 2011; 85: 5070–80.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Michael R. Ardern-Jones.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bristow, I., Lim, W.C., Lee, A. et al. Microwave therapy for cutaneous human papilloma virus infection. Eur J Dermatol 27, 511–518 (2017).

Download citation

Key words

  • warts
  • microwave
  • CD8+ T cells
  • HPV