American Journal of Clinical Dermatology

, Volume 1, Issue 3, pp 143–149 | Cite as


Guidelines for Management
  • Joyce A. Leman
  • E. Claire Benton
Disease Management


Most people will experience infection with human papilloma virus (HPV) at some point in their life. Diagnosis, based on clinical examination, is usually straight forward. Treatment can, however, be challenging.

Indications for treatment include pain, interference with function, cosmetic embarrassment, and risk of malignancy. Clearance rates are highest in young, healthy individuals with short duration of infection.

Treatment may be with destructive agents (keratolytics, cryotherapy, curettage and cautery, laser, photodynamic therapy), with antimitotic agents (podophyllin, bleomycin, retinoids), with immune stimulants (topical sensitizers, cimetidine), or with topical virucidal agents [formaldehyde (formalin), glutaral (gluteraldehyde)].

As yet, there is no single totally effective treatment for viral warts. Some patients may choose to leave their warts untreated until spontaneous resolution. In those who seek intervention, simple, well tolerated therapies should be chosen initially in preference to more complicated, potentially harmful agents. It is likely that future research will be directed to developing an antiviral agent specific for HPV which would be safe, effective and not prohibitively expensive.


Salicylic Acid Human Papilloma Virus Imiquimod Human Papilloma Virus Infection Cantharidin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ross M.S. Warts in the medical folklore of Europe. Int J Dermatol 1979; 18: 505–509PubMedCrossRefGoogle Scholar
  2. 2.
    Zur Hausen H. Roots and perspective of contemporary papilloma virus research.J Cancer Res Clin 1996; 122: 3–13CrossRefGoogle Scholar
  3. 3.
    Burns P.A. Warts and all the history and folklore of warts: a review. J R Soc Med1992; 85: 37–40Google Scholar
  4. 4.
    Strauss M.J., Shaw E.W., Bunting H., et al. ‘Crystalline’ virus like particles from skin paplomas characterised by intranuclear inclusion bodies. Proc Soc Exp Bio Med 1949; 72: 46–50Google Scholar
  5. 5.
    Melnick J.L. Papova virus group. Science 1962; 135: 1128–1130PubMedCrossRefGoogle Scholar
  6. 6.
    Zur Hausen H., de Villers E.M. Human papilloma viruses. Ann Rev Microbiol 1994; 48: 427–447CrossRefGoogle Scholar
  7. 7.
    Androphy E.J. Biology of human papilloma virus infection and oncogenesis. J Invest Dermatol 1994; 103: 248–256PubMedCrossRefGoogle Scholar
  8. 8.
    Stem R.S., Johnson M.L., de Lozier J. Utilisation of physician services for dermatological complaints. Arch Dermatol 1997; 113: 1062Google Scholar
  9. 9.
    Bart B.J., Biglow J., Vance J.C., et al. Salicylic acid in karaya gum patch as treatment for verruca vulgaris. J Am Acad Dermatol 1989; 20: 74–76PubMedCrossRefGoogle Scholar
  10. 10.
    Veien N.K., Madsen S.M., Avrach W., et al. The treatment of plantar warts with a keratolytic agent and occlusion. J Dermatol Treat 1991; 2: 59–61CrossRefGoogle Scholar
  11. 11.
    Bunney M.H., Nolan M., Williams D. An assessment of methods of treating viral warts by comparative trials based on standard design. Br J Dermatol 1976; 94: 667–679PubMedCrossRefGoogle Scholar
  12. 12.
    Cameli N., Vassilopoulou A., Vincenzi C. Contact allergy to colophony in a wart remover. Contact Derm 1991; 24: 315–316PubMedCrossRefGoogle Scholar
  13. 13.
    Hirose R., Hori M., Shukuwa T., et al. Topical treatment of resistant warts with gluteraldehyde. Dermatology 1994; 21: 248–253Google Scholar
  14. 14.
    Thomson S. The treatment of plantar warts by formalin. Br J Dermatol 1943; 55: 267–269CrossRefGoogle Scholar
  15. 15.
    Bunney M.H., Nolan M.W., Buxton P.K., et al. The treatment of resistant warts with intralesional Bleomycin: a controlled trial. Br J Dermatol 1984; 110: 197–207CrossRefGoogle Scholar
  16. 16.
    Shelly W.B., Shelly E.D. Intralesional bleomycin sulphate therapy for warts. Arch Dermatol 1991; 127: 234–236CrossRefGoogle Scholar
  17. 17.
    Hayes M.E., O’Keefe E.J. Reduced dose of bleomycin in the treatment of recalcitrant warts. J Am Acad Dermatol 1986; 15: 1002–1006PubMedCrossRefGoogle Scholar
  18. 18.
    DePablo P., Aguffiar A., Gallego M.A. Raynaud’s phenomenon and intralesional bleomycin [letter]. Acta Derma Venereol 1992; 72: 465Google Scholar
  19. 19.
    Epstein E. Intralesional bleomycin and Raynaud’s phenomenon. J Am Acad Dermatol 1991; 24: 785–786PubMedCrossRefGoogle Scholar
  20. 20.
    Miller R.W. Nail dystrophy following intralesional injection of bleomycin for a painful wart. Arch Dermatol 1984; 120: 963–964PubMedCrossRefGoogle Scholar
  21. 21.
    Allen A.L., Fosko S.W. Lymphangitis as a complication of intralesional bleomycin therapy. J Am Acad Dermatol 1998; 39: 295–297PubMedCrossRefGoogle Scholar
  22. 22.
    Epstein W.L., Kligam A.M. Treatment of warts with cantharidin. Arch Dermatol1958; 77: 508–511CrossRefGoogle Scholar
  23. 23.
    Dilaimy M. Lymphangitis caused by cantharidin. Arch Dermatol 1975; 111: 1073PubMedCrossRefGoogle Scholar
  24. 24.
    Stazzone A., Borgs P., Witte C., et al. Lymphangitis and refractory lymphoedema after treatment of topical cantharidin. Arch Dermatol 1998; 134: 105–106CrossRefGoogle Scholar
  25. 25.
    Boyle J., Dick D.C., Maclde R.M. Treatment of extensive viral warts with etretinate in a patient with sarcoid. Clin Exp Dermatol 1983; 8: 33–36PubMedCrossRefGoogle Scholar
  26. 26.
    Gross G., Pfister H., Hagedorn M., et al. Effect of oral aromatic retinoid (Ro 9359) on human papilloma virus -2 induced common warts. Dermatologica 1983; 166: 48–53PubMedCrossRefGoogle Scholar
  27. 27.
    Rogozinski T., Geizer J.M., Czametzki B.M., et al. Acitretin in the treatment and prevention of viral, premalignant and malignant skin lesions. J Dermatol Treat1989; 1: 91–93CrossRefGoogle Scholar
  28. 28.
    Euvarard S., Vershooreu M., Touraine J.L., et al. Topical retinoids for warts and keratoses in renal transplant recipients. Lancet 1992; 340: 48–49CrossRefGoogle Scholar
  29. 29.
    Shuttleworth D., Marks R., Griffin P.J.A., et al. Treatment of cutaneous neoplasia with etretinate in renal transplant recipients. Q J Med 1998; 68: 717–724Google Scholar
  30. 30.
    Pazin G.J., Ho M., Haveros H.W., et al. Effects of interferon alpha in human warts. J Interferon Res 1982; 2: 235–243PubMedCrossRefGoogle Scholar
  31. 31.
    Gibson J.R., Harvey S.G., Kemmett D.K., et al. Treatment of common and plantar warts with human lymphoblastoid intereferon alpha: pilot studies with intralesional and intramuscular and dermojet injections. Br J Dermatol 1986; 115 Suppl. 31: 76–79PubMedCrossRefGoogle Scholar
  32. 32.
    Vance J.C., Bart B.J., Hansen R.C., et al. Intralesional recombinant interferon for the treatment of patients with conylomata accuminata or verruca plantaris. Arch Dermatol 1986; 122: 272–277PubMedCrossRefGoogle Scholar
  33. 33.
    Berman B., Davis Reed L., Silverstein L., et al. Treatment of verrucal vulgaris with alpha 2 interferon. J Infect Dis 1986; 154: 328–330PubMedCrossRefGoogle Scholar
  34. 34.
    Pazin G.J., Ho M., Haverkos H.W., et al. Effects of interferon alpha in human warts. J Interfer Res 1982; 2: 235–243CrossRefGoogle Scholar
  35. 35.
    Buckner D., Price N. Immunotherapy of verrucae vulgaris with dinitrochlorobenzene.Br J Dermatol 1978; 98: 451–455PubMedCrossRefGoogle Scholar
  36. 36.
    Young H.R. DNCB reported effective for recalcitrant warts. Skin Allergy News1976; 7: 19Google Scholar
  37. 37.
    Orrechia G., Douville H., Santagostina L., et al. Treatment of multiple relapsing warts with diphencyprone. Dermatologica 1988; 177: 225–231CrossRefGoogle Scholar
  38. 38.
    Naylor M.F., Nelder K.H., Yarborough G.K., et al. Contact immunotherapy of resistant warts. J Am Acad Dermatol 1988; 19 (4): 679–683PubMedCrossRefGoogle Scholar
  39. 39.
    Lee A.N., Mallory S.B. Contact immunotherapy with squaric acid dibutylester for the treatment of recalcitrant warts. J Am Acad Dermatol 1999; 41: 595–599PubMedGoogle Scholar
  40. 40.
    Schon M., Helin P. Levamisole in a double blind study. No effect on warts. Acta Derm Venereol 1977; 57: 449–454Google Scholar
  41. 41.
    Benton E.C., Nolan M.W., Kemmett D.K., et al. Trial of inosine pranobex in the management of cutaneous warts. J Dermatol Treat 1991; 1: 295–297CrossRefGoogle Scholar
  42. 42.
    Orlow S.J., Paller A. Cimetidine therapy for multiple viral warts in children. J Am Acad Dermatol 1993; 28: 794–796PubMedCrossRefGoogle Scholar
  43. 43.
    Glass A.T., Solomon B.A. Cimetidine therapy for recalcitrant warts in adults. Arch Dermatol 1996; 132: 680–682PubMedCrossRefGoogle Scholar
  44. 44.
    Choi Y.S., Hanon S.K., Park Y.K. The effect of cimetidine on verruca plane juvenilia; clinical trials in 6 patients. J Dermatol 1993; 20: 497–500PubMedGoogle Scholar
  45. 45.
    Yilmaz E., Alpsoy E., Basaran E. Cimetidine therapy for warts; A placebo controlled double blind study. J Am Acad Dermatol 1996; 34: 1005–1007PubMedCrossRefGoogle Scholar
  46. 46.
    Beutner K.R., Geisse J.K. Imiquimod: an immune response modifier for the treatment of genital warts. Todays Therapeutic Trends 1997; 15 (3): 165–178Google Scholar
  47. 47.
    Bunney M.H., Benton E.C., Cubie H.A. Cryotherapy. In: Viral warts: biology and treatment. 2nd ed. Oxford: Oxford Medical Publications 1992: 108–205Google Scholar
  48. 48.
    Bourke J.F., Berth-Jones J., Hutchison P.E. Cryotherapy of common viral warts at intervals of 1, 2 and 3 weeks. Br J Dermatol 1990; 132: 115–120Google Scholar
  49. 49.
    Street M.L., Roenigk R.K. Recalcitrant periungal verrucae: the role of carbon dioxide laser vaporisation. J Am Acad Dermatol 1990; 132: 115–120CrossRefGoogle Scholar
  50. 50.
    Jain A., Sorwick G.S. Effectiveness of the 585 run flashlamp tunable dye laser (PDTL) for treatment of plantar verrucae. Lasers Sug Med 1997; 21 (5): 500–505CrossRefGoogle Scholar
  51. 51.
    Borovoy M.A., Borovoy M., Elxon L.M., et al. Flashlamp pulsed dye laser (585 mn) treatment of resistant verrucae. J Am Pod Med Assoc 1996; 86 (11): 547–550Google Scholar
  52. 52.
    Alec M., Ursaciuc C., Halalau F., et al. Photodynamic treatment of basal cell carcinoma and squamous cell carcinoma with hyercin. Anticancer Res 1998; 18 (6B): 4561–4564Google Scholar
  53. 53.
    Hurliman A.F., Hanggi G., Panzzon R.G. Photodynamic therapy of superficial basal cell carcinomas using topical 5 aminolevulinic acid in a noncolloid lotion. Dermatology1998; 197 (3): 248–254CrossRefGoogle Scholar
  54. 54.
    Kurwa H.A., Yong Gee S.A., Seed P.T., et al. A randomised paired comparison of photodynamic therapy and topical 5 fluorouracil in the treatment of actinic keratoses.J Am Acad Dermatol 1999; 41 (3 Pt 1): 414–418PubMedCrossRefGoogle Scholar
  55. 55.
    Szimies R.M., Karrer S., Sauerwald A., et al. Photodynamic therapy with topical 5 aminolevulinic acid in the treatment of actinic keratoses: an initial clinical study.Dermatology 1996; 192 (3): 246–51CrossRefGoogle Scholar
  56. 56.
    Stender I.N.I., Wulf H.C. The treatment of recalcitrant verrucae by Photodynamic therapy with topical delta aminolaevulinic acid [letter]. Clin Exp Dermatol; 1996: 21: 388–396CrossRefGoogle Scholar
  57. 57.
    Stender I.M., Na R., Fogh H., et al. Photodynamic therapy with 5 aminolaevulinic acid or placebo for recalcitrant foot and hand warts; a randomised double blind trial. Lancet 2000; 555: 963–966CrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Joyce A. Leman
    • 1
  • E. Claire Benton
    • 1
  1. 1.Department of DermatologyRoyal Infirmary of EdinburghEdinburghScotland

Personalised recommendations