A comprehensive review of treatment options for recalcitrant nongenital cutaneous warts

References

• Bruggink SC, de Koning MN, Gussekloo J, et al. Cutaneous wart-associated HPV types: prevalence and relation with patient characteristics. J Clin Virol. 2012;55:250–255.
   PubMed Web of Science ®Google Scholar
• Kilkenny M, Merlin K, Young R, et al. The prevalence of common skin conditions in Australian school students: 1. Common, plane and plantar viral warts. Br J Dermatol. 1998;138:840–845.
   PubMed Web of Science ®Google Scholar
• Sterling JC, Gibbs S, Haque Hussain SS, et al. British Association of Dermatologists’ guidelines for the management of cutaneous warts 2014. Br J Dermatol. 2014;171:696–712.
   PubMed Web of Science ®Google Scholar
• Thappa DM, Chiramel MJ. Evolving role of immunotherapy in the treatment of refractory warts. Indian Dermatol Online J. 2016;7:364–370.
   PubMedGoogle Scholar
• Allen AL, Siegfried EC. What’s new in human papillomavirus infection. Curr Opin Pediatr. 2000;12:365–369.
   PubMed Web of Science ®Google Scholar
• Sterling JC, Handfield-Jones S, Hudson PM. Guidelines for the management of cutaneous warts. Br J Dermatol. 2001;144:4–11.
   PubMed Web of Science ®Google Scholar
• Leung L. Treating common warts – options and evidence. Aust Fam Physician. 2010;39:933–937.
   PubMedGoogle Scholar
• Choi Y, Kim DH, Jin SY, et al. Topical immunotherapy with diphenylcyclopropenone is effective and preferred in the treatment of periungual warts. Ann Dermatol. 2013;25:434–439.
   PubMed Web of Science ®Google Scholar
• Logan RA, Zachary CB. Outcome of carbon dioxide laser therapy for persistent cutaneous viral warts. Br J Dermatol. 1989;121:99–105.
   PubMed Web of Science ®Google Scholar
• Hruza GJ. Laser treatment of warts and other epidermal and dermal lesions. Dermatol Clin. 1997;15:487–506.
   PubMed Web of Science ®Google Scholar
• Nguyen J, Korta DZ, Chapman LW, et al. Laser treatment of nongenital verrucae: a systematic review. JAMA Dermatol. 2016;152:1025–1034.
   PubMed Web of Science ®Google Scholar
• Street ML, Roenigk RK. Recalcitrant periungual verrucae: the role of carbon dioxide laser vaporization. J Am Acad Dermatol. 1990;23:115–120.
   PubMed Web of Science ®Google Scholar
• Lim JT, Goh CL. Carbon dioxide laser treatment of periungual and subungual viral warts. Australas J Dermatol. 1992;33:87–91.
   PubMedGoogle Scholar
• Sloan K, Haberman H, Lynde CW. Carbon dioxide laser-treatment of resistant verrucae vulgaris: retrospective analysis. J Cutan Med Surg. 1998;2:142–145.
   PubMedGoogle Scholar
• Serour F, Somekh E. Successful treatment of recalcitrant warts in pediatric patients with carbon dioxide laser. Eur J Pediatr Surg. 2003;13:219–223.
   PubMed Web of Science ®Google Scholar
• Lauchli S, Kempf W, Dragieva G, et al. CO2 laser treatment of warts in immunosuppressed patients. Dermatology. 2003;206:148–152.
   PubMed Web of Science ®Google Scholar
• Oni G, Mahaffey PJ. Treatment of recalcitrant warts with the carbon dioxide laser using an excision technique. J Cosmet Laser Ther. 2011;13:231–236.
   PubMed Web of Science ®Google Scholar
• Balevi A, Ustuner P, Ozdemir M. Use of Er:YAG for the treatment of recalcitrant facial verruca plana. J Dermatolog Treat. 2017;28:368–371.
   PubMed Web of Science ®Google Scholar
• Jacobsen E, McGraw R, McCagh S. Pulsed dye laser efficacy as initial therapy for warts and against recalcitrant verrucae. Cutis. 1997;59:206–208.
   PubMed Web of Science ®Google Scholar
• Kenton-Smith J, Tan ST. Pulsed dye laser therapy for viral warts. Br J Plast Surg. 1999;52:554–558.
   PubMedGoogle Scholar
• Kopera D. Verrucae vulgares: flashlamp-pumped pulsed dye laser treatment in 134 patients. Int J Dermatol. 2003;42:905–908.
   PubMed Web of Science ®Google Scholar
• Akarsu S, Ilknur T, Demirtaşoǧlu M, et al. Verruca vulgaris: pulsed dye laser therapy compared with salicylic acid + pulsed dye laser therapy. J Eur Acad Dermatol Venereol. 2006;20:936–940.
   PubMed Web of Science ®Google Scholar
• Park HS, Choi WS. Pulsed dye laser treatment for viral warts: a study of 120 patients. J Dermatol. 2008;35:491–498.
   PubMed Web of Science ®Google Scholar
• Sethuraman G, Richards KA, Hiremagalore RN, et al. Effectiveness of pulsed dye laser in the treatment of recalcitrant warts in children. Dermatol Surg. 2010;36:58–65.
   PubMed Web of Science ®Google Scholar
• Sparreboom EE, Luijks HG, Luiting-Welkenhuyzen HA, et al. Pulsed-dye laser treatment for recalcitrant viral warts: a retrospective case series of 227 patients. Br J Dermatol. 2014;171:1270–1273.
   PubMed Web of Science ®Google Scholar
• Li Y, Yang K. Treatment of recalcitrant-pigmented flat warts using frequency-doubled Q-switched Nd–YAG laser. Lasers Surg Med. 2001;29:244–247.
   PubMed Web of Science ®Google Scholar
• El-Mohamady Ael S, Mearag I, El-Khalawany M, et al. Pulsed dye laser versus Nd:YAG laser in the treatment of plantar warts: a comparative study. Lasers Med Sci. 2014;29:1111–1116.
   PubMed Web of Science ®Google Scholar
• Kimura U, Takeuchi K, Kinoshita A, et al. Long-pulsed 1064-nm neodymium:yttrium–aluminum–garnet laser treatment for refractory warts on hands and feet. J Dermatol. 2014;41:252–257.
   PubMed Web of Science ®Google Scholar
• Bingol UA, Comert A, Cinar C. The overlapped triple circle pulse technique with Nd:YAG laser for refractory hand warts. Photomed Laser Surg. 2015;33:338–342.
   PubMed Web of Science ®Google Scholar
• Smith EA, Patel SB, Whiteley MS. Evaluating the success of Nd:YAG laser ablation in the treatment of recalcitrant verruca plantaris and a cautionary note about local anaesthesia on the plantar aspect of the foot. J Eur Acad Dermatol Venereol. 2015;29:463–467.
   PubMed Web of Science ®Google Scholar
• Alshami MA, Mohana MJ. Novel treatment approach for deep palmoplantar warts using long-pulsed 1064-nm Nd:YAG laser and a moisturizing cream without prior paring of the wart surface. Photomed Laser Surg. 2016;34:448–455.
   PubMed Web of Science ®Google Scholar
• Shin YS, Cho EB, Park EJ, et al. A comparative study of pulsed dye laser versus long pulsed Nd:YAG laser treatment in recalcitrant viral warts. J Dermatolog Treat. 2017;28:411–416.
   PubMed Web of Science ®Google Scholar
• Khattab FM, Khashaba SA. Evaluation of combined treatment with long-pulsed neodymium-doped yttrium aluminum garnet laser and potassium hydroxide for the treatment of recalcitrant wart: a prospective comparative study. J Dermatolog Treat. 2020;31:56–60.
   PubMed Web of Science ®Google Scholar
• Yang C, Liu S, Yang S. Treatment of facial recalcitrant verruca vulgaris with holmium:YAG laser: an update. J Cosmet Laser Ther. 2013;15:39–41.
   PubMed Web of Science ®Google Scholar
• Gooptu C, James MP. Recalcitrant viral warts: results of treatment with the KTP laser. Clin Exp Dermatol. 1999;24:60–63.
   PubMed Web of Science ®Google Scholar
• Stender IM, Na R, Fogh H, et al. Photodynamic therapy with 5-aminolaevulinic acid or placebo for recalcitrant foot and hand warts: randomised double-blind trial. Lancet. 2000;355:963–966.
   PubMed Web of Science ®Google Scholar
• Smucler R, Jatsova E. Comparative study of aminolevulic acid photodynamic therapy plus pulsed dye laser versus pulsed dye laser alone in treatment of viral warts. Photomed Laser Surg. 2005;23:202–205.
   PubMed Web of Science ®Google Scholar
• Yoo KH, Kim BJ, Kim MN. Enhanced efficacy of photodynamic therapy with methyl 5-aminolevulinic acid in recalcitrant periungual warts after ablative carbon dioxide fractional laser: a pilot study. Dermatol Surg. 2009;35:1927–1932.
   PubMed Web of Science ®Google Scholar
• Fernandez-Guarino M, Harto A, Jaen P. Treatment of recalcitrant viral warts with pulsed dye laser MAL-PDT. J Dermatolog Treat. 2011;22:226–228.
   PubMed Web of Science ®Google Scholar
• Li Q, Jiao B, Zhou F, et al. Comparative study of photodynamic therapy with 5%, 10% and 20% aminolevulinic acid in the treatment of generalized recalcitrant facial verruca plana: a randomized clinical trial. J Eur Acad Dermatol Venereol. 2014;28:1821–1826.
   PubMed Web of Science ®Google Scholar
• Qian G, Wang S, Deng D, et al. Is the step-up therapy of topical 5-aminolevulinic acid photodynamic therapy effective and safe for the patients with recalcitrant facial flat wart? Dermatol Ther. 2014;27:83–88.
   PubMed Web of Science ®Google Scholar
• Yang YL, Sang J, Liao NX, et al. Off-label photodynamic therapy for recalcitrant facial flat warts using topical 5-aminolevulinic acid. Lasers Med Sci. 2016;31:929–936.
   PubMed Web of Science ®Google Scholar
• Wu L, Chen W, Su J, et al. Efficacy of the combination of superficial shaving with photodynamic therapy for recalcitrant periungual warts. Photodiagn Photodyn Ther. 2019;27:340–344.
   PubMed Web of Science ®Google Scholar
• Gao J, Shen C, Ko R, et al. Combination effect of super pulsed carbon dioxide laser and photodynamic therapy for recalcitrant facial flat warts: a preliminary study. J Cosmet Laser Ther. 2016;18:56–57.
   PubMed Web of Science ®Google Scholar
• Song W, Zhang J, Gao N, et al. A combination of 2940-nm laser and photodynamic therapy in treatment for recalcitrant facial flat warts. Photodiagn Photodyn Ther. 2019;26:97–100.
   PubMed Web of Science ®Google Scholar
• Vogel S, Ruzicka T, Berking C. Subluminescence photodynamic therapy of recalcitrant foot warts. Br J Dermatol. 2015;172:813–816.
   PubMed Web of Science ®Google Scholar
• Alcantara-Gonzalez J, Calzado-Villarreal L, Sanchez-Largo ME, et al. Recalcitrant viral warts treated with photodynamic therapy methyl aminolevulinate and red light (630 nm): a case series of 51 patients. Lasers Med Sci. 2020;35:229–231.
   PubMed Web of Science ®Google Scholar
• Kartal Durmazlar SP, Atacan D, Eskioglu F. Cantharidin treatment for recalcitrant facial flat warts: a preliminary study. J Dermatolog Treat. 2009;20:114–119.
   PubMed Web of Science ®Google Scholar
• Lopez Lopez D, Vilar Fernandez JM, Losa Iglesias ME, et al. Safety and effectiveness of cantharidin–podophyllotoxin–salicylic acid in the treatment of recalcitrant plantar warts. Dermatol Ther. 2016;29:269–273.
   PubMed Web of Science ®Google Scholar
• Ghonemy S. Treatment of recalcitrant plantar warts with long-pulsed Nd:YAG laser versus cantharidin–podophylline resin–salicylic acid. J Cosmet Laser Ther. 2017;19:347–352.
   PubMed Web of Science ®Google Scholar
• Jiang SB, Levine VJ, Nehal KS, et al. Er:YAG laser for the treatment of actinic keratoses. Dermatol Surg. 2000;26:437–440.
   PubMed Web of Science ®Google Scholar
• Kaufmann R, Hartmann A, Hibst R. Cutting and skin-ablative properties of pulsed mid-infrared laser surgery. J Dermatol Surg Oncol. 1994;20:112–118.
   PubMedGoogle Scholar
• Wollina U, Konrad H, Karamfilov T. Treatment of common warts and actinic keratoses by Er:YAG laser. J Cutan Laser Ther. 2001;3:63–66.
   PubMedGoogle Scholar
• Robson KJ, Cunningham NM, Kruzan KL, et al. Pulsed-dye laser versus conventional therapy in the treatment of warts: a prospective randomized trial. J Am Acad Dermatol. 2000;43:275–280.
   PubMed Web of Science ®Google Scholar
• Akhyani M, Ehsani AH, Noormohammadpour P, et al. Comparing pulsed-dye laser with cryotherapy in the treatment of common warts. J Lasers Med Sci. 2010;1:14–19.
   Google Scholar
• Izikson L, Nelson JS, Anderson RR. Treatment of hypertrophic and resistant port wine stains with a 755 nm laser: a case series of 20 patients. Lasers Surg Med. 2009;41:427–432.
   PubMed Web of Science ®Google Scholar
• Pharaon M, Le Duff F, Montaudie H, et al. Long pulse Alexandrite laser for recalcitrant viral warts on the hands. J Eur Acad Dermatol Venereol. 2016;30:1394–1395.
   PubMed Web of Science ®Google Scholar
• Bekhor PS, Entwisle BR, McKenzie IF. Topical DNCB therapy for resistant warts. Australas J Dermatol. 1978;19:28–30.
   PubMed Web of Science ®Google Scholar
• Dunagin WG, Millikan LE. Dinitrochlorobenzene immunotherapy for verrucae resistant to standard treatment modalities. J Am Acad Dermatol. 1982;6:40–45.
   PubMed Web of Science ®Google Scholar
• Naylor MF, Neldner KH, Yarbrough GK, et al. Contact immunotherapy of resistant warts. J Am Acad Dermatol. 1988;19:679–683.
   PubMed Web of Science ®Google Scholar
• Rampen FH, Steijlen PM. Diphencyprone in the management of refractory palmoplantar and periungual warts: an open study. Dermatology. 1996;193:236–238.
   PubMed Web of Science ®Google Scholar
• Suh DW, Lew BL, Sim WY. Investigations of the efficacy of diphenylcyclopropenone immunotherapy for the treatment of warts. Int J Dermatol. 2014;53:e567–e571.
   PubMed Web of Science ®Google Scholar
• Uptis JA, Krol A. The use of diphenylcyclopropenone in the treatment of recalcitrant warts. J Cutan Med Surg. 2002;6:214–217.
   PubMed Web of Science ®Google Scholar
• Buckley DA, Keane FM, Munn SE, et al. Recalcitrant viral warts treated by diphencyprone immunotherapy. Br J Dermatol. 1999;141:292–296.
   PubMed Web of Science ®Google Scholar
• Lee AN, Mallory SB. Contact immunotherapy with squaric acid dibutylester for the treatment of recalcitrant warts. J Am Acad Dermatol. 1999;41:595–599.
   PubMed Web of Science ®Google Scholar
• Dall’Oglio F, Luca M, Barresi S, et al. Treatment of multiple-resistant and/or recurrent cutaneous warts with squaric acid dibutylester: a randomized, double-blind, vehicle-controlled clinical trial. Dermatitis. 2017;28:308–312.
   PubMed Web of Science ®Google Scholar
• Micali G, Nasca MR, Tedeschi A, et al. Use of squaric acid dibutylester (SADBE) for cutaneous warts in children. Pediatr Dermatol. 2000;17:315–318.
   PubMed Web of Science ®Google Scholar
• Edwards L. Imiquimod in clinical practice. J Am Acad Dermatol. 2000;43:S12–S17.
   PubMed Web of Science ®Google Scholar
• Grussendorf-Conen EI, Jacobs S, Rubben A, et al. Topical 5% imiquimod long-term treatment of cutaneous warts resistant to standard therapy modalities. Dermatology. 2002;205:139–145.
   PubMed Web of Science ®Google Scholar
• Micali G, Dall'Oglio F, Nasca MR. An open label evaluation of the efficacy of imiquimod 5% cream in the treatment of recalcitrant subungual and periungual cutaneous warts. J Dermatolog Treat. 2003;14:233–236.
   PubMedGoogle Scholar
• Park SM, Kim GW, Mun JH, et al. Fractional laser-assisted topical imiquimod 5% cream treatment for recalcitrant common warts in children: a pilot study. Dermatol Surg. 2016;42:1340–1346.
   PubMed Web of Science ®Google Scholar
• Zeng Y, Zheng YQ, Wang L. Vagarious successful treatment of recalcitrant warts in combination with CO2 laser and imiquimod 5% cream. J Cosmet Laser Ther. 2014;16:311–313.
   PubMed Web of Science ®Google Scholar
• Goihman-Yahr M. Combined immunotherapy of recalcitrant warts. Int J Dermatol. 2006;45:627.
   PubMed Web of Science ®Google Scholar
• Salman S, Ahmed MS, Ibrahim AM, et al. Intralesional immunotherapy for the treatment of warts: a network meta-analysis. J Am Acad Dermatol. 2019;80:922–930 e4.
   PubMed Web of Science ®Google Scholar
• Nofal A, Nofal E. Intralesional immunotherapy of common warts: successful treatment with mumps, measles and rubella vaccine. J Eur Acad Dermatol Venereol. 2010;24:1166–1170.
   PubMed Web of Science ®Google Scholar
• Abd-Elazeim FM, Mohammed GF, Fathy A, et al. Evaluation of IL-12 serum level in patients with recalcitrant multiple common warts, treated by intralesional tuberculin antigen. J Dermatolog Treat. 2014;25:264–267.
   PubMed Web of Science ®Google Scholar
• Johnson SM, Horn TD. Intralesional immunotherapy for warts using a combination of skin test antigens: a safe and effective therapy. J Drugs Dermatol. 2004;3:263–265.
   PubMedGoogle Scholar
• Amirnia M, Khodaeiani E, Fouladi DF, et al. Intralesional immunotherapy with tuberculin purified protein derivative (PPD) in recalcitrant wart: a randomized, placebo-controlled, double-blind clinical trial including an extra group of candidates for cryotherapy. J Dermatolog Treat. 2016;27:173–178.
   PubMed Web of Science ®Google Scholar
• Kus S, Ergun T, Gun D, et al. Intralesional tuberculin for treatment of refractory warts. J Eur Acad Dermatol Venerol. 2005;19:515–516.
   PubMed Web of Science ®Google Scholar
• Dhakar AK, Dogra S, Vinay K, et al. Intralesional Mycobacterium w vaccine versus cryotherapy in treatment of refractory extragenital warts: a randomized, open-label, comparative study. J Cutan Med Surg. 2016;20:123–129.
   PubMed Web of Science ®Google Scholar
• Chandra S, Sil A, Datta A, et al. A double-blind, randomized controlled trial to compare the effectiveness and safety of purified protein derivative of tuberculin antigen with Mycobacterium w vaccine in the treatment of multiple viral warts. Indian J Dermatol Venereol Leprol. 2019;85:355–366.
   PubMed Web of Science ®Google Scholar
• Nofal A, Yosef A, Salah E. Treatment of recalcitrant warts with Bacillus Calmette-Guérin: a promising new approach. Dermatol Ther. 2013;26:481–485.
   PubMed Web of Science ®Google Scholar
• Kumar P, Das A. Excellent response to intralesional bacilus Calmette-Guerin vaccine in a recalcitrant periungual wart. J Cutan Aesthet Surg. 2014;7:234–235.
   PubMedGoogle Scholar
• Daulatabad D, Pandhi D, Singal A. BCG vaccine for immunotherapy in warts: is it really safe in a tuberculosis endemic area? Dermatol Ther. 2016;29:168–172.
   PubMed Web of Science ®Google Scholar
• Shaheen MA, Salem SA, Fouad DA, et al. Intralesional tuberculin (PPD) versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: a comparative clinical and immunological study. Dermatol Ther. 2015;28:194–200.
   PubMed Web of Science ®Google Scholar
• Nofal A, Nofal E, Yosef A, et al. Treatment of recalcitrant warts with intralesional measles, mumps, and rubella vaccine: a promising approach. Int J Dermatol. 2015;54:667–671.
   PubMed Web of Science ®Google Scholar
• Rezai MS, Ghasempouri H, Asqary Marzidareh O, et al. Intralesional injection of the measles–mumps–rubella vaccine into resistant palmoplantar warts: a randomized controlled trial. Iran J Med Sci. 2019;44:10–17.
   PubMed Web of Science ®Google Scholar
• Majid I, Imran S. Immunotherapy with intralesional Candida albicans antigen in resistant or recurrent warts: a study. Indian J Dermatol. 2013;58:360–365.
   PubMedGoogle Scholar
• Phillips RC, Ruhl TS, Pfenninger JL, et al. Treatment of warts with Candida antigen injection. Arch Dermatol. 2000;136:1274–1275.
   PubMed Web of Science ®Google Scholar
• Munoz Garza FZ, Roe Crespo E, Torres Pradilla M, et al. Intralesional Candida antigen immunotherapy for the treatment of recalcitrant and multiple warts in children. Pediatr Dermatol. 2015;32:797–801.
   PubMed Web of Science ®Google Scholar
• Marei A, Nofal A, Alakad R, et al. Combined bivalent human papillomavirus vaccine and Candida antigen versus Candida antigen alone in the treatment of recalcitrant warts. J Cosmet Dermatol. 2020;19:758–762.
   PubMed Web of Science ®Google Scholar
• Clifton MM, Johnson SM, Roberson PK, et al. Immunotherapy for recalcitrant warts in children using intralesional mumps or Candida antigens. Pediatr Dermatol. 2003;20:268–271.
   PubMed Web of Science ®Google Scholar
• Nofal A, Marei A, Ibrahim AM, et al. Intralesional versus intramuscular bivalent human papillomavirus vaccine in the treatment of recalcitrant common warts. J Am Acad Dermatol. 2020;82:94–100.
   PubMed Web of Science ®Google Scholar
• Raghukumar S, Ravikumar BC, Vinay KN, et al. Intralesional vitamin D3 injection in the treatment of recalcitrant warts: a novel proposition. J Cutan Med Surg. 2017;21:320–324.
   PubMed Web of Science ®Google Scholar
• Fathy G, Sharara MA, Khafagy AH. Intralesional vitamin D3 versus Candida antigen immunotherapy in the treatment of multiple recalcitrant plantar warts: a comparative case-control study. Dermatol Ther. 2019;32:e12997.
   PubMed Web of Science ®Google Scholar
• Abou-Taleb DAE, Abou-Taleb HA, El-Badawy O, et al. Intralesional vitamin D3 versus intralesional purified protein derivative in treatment of multiple warts: a comparative clinical and immunological study. Dermatol Ther. 2019;32:e13034.
   PubMed Web of Science ®Google Scholar
• Nofal A, Khattab F, Nofal E, et al. Combined acitretin and Candida antigen versus either agent alone in the treatment of recalcitrant warts. J Am Acad Dermatol. 2018;79:377–378.
   PubMed Web of Science ®Google Scholar
• Sharquie KA, Al-Nuaimy AA. Treatment of viral warts by intralesional injection of zinc sulphate. Ann Saudi Med. 2002;22:26–28.
   PubMed Web of Science ®Google Scholar
• El Taweel AA, Salem R, Allam A. Intralesional 2% zinc sulfate solution for plane warts: a case report. Dermatol Ther. 2019;32:e12761.
   PubMed Web of Science ®Google Scholar
• Wong A, Crawford RI. Intralesional Candida antigen for common warts in people with HIV. J Cutan Med Surg. 2013;17:313–315.
   PubMed Web of Science ®Google Scholar
• Johnson SM, Roberson PK, Horn TD. Intralesional injection of mumps or Candida skin test antigens: a novel immunotherapy for warts. Arch Dermatol. 2001;137:451–455.
   PubMed Web of Science ®Google Scholar
• Egawa K, Ono T. Topical vitamin D3 derivatives for recalcitrant warts in three immunocompromised patients. Br J Dermatol. 2004;150:374–376.
   PubMed Web of Science ®Google Scholar
• Moscarelli L, Annunziata F, Mjeshtri A, et al. Successful treatment of refractory wart with a topical activated vitamin d in a renal transplant recipient. Case Rep Transplant. 2011;2011:368623.
   PubMedGoogle Scholar
• Imagawa I, Suzuki H. Successful treatment of refractory warts with topical vitamin D3 derivative (maxacalcitol, 1alpha, 25-dihydroxy-22-oxacalcitriol) in 17 patients. J Dermatol. 2007;34:264–266.
   PubMed Web of Science ®Google Scholar
• Osborne JE, Hutchinson PE. Vitamin D and systemic cancer: is this relevant to malignant melanoma? Br J Dermatol. 2002;147:197–213.
   PubMed Web of Science ®Google Scholar
• Liu PT, Stenger S, Li H, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311:1770–1773.
   PubMed Web of Science ®Google Scholar
• Dehghani F, Merat A, Panjehshahin MR, et al. Healing effect of garlic extract on warts and corns. Int J Dermatol. 2005;44:612–615.
   PubMed Web of Science ®Google Scholar
• Kenawy S, Mohammed GF, Younes S, et al. Evaluation of TNF-alpha serum level in patients with recalcitrant multiple common warts, treated by lipid garlic extract. Dermatol Ther. 2014;27:272–277.
   PubMed Web of Science ®Google Scholar
• Avunduk AM, Avunduk MC, Baltaci AK, et al. Effect of melatonin and zinc on the immune response in experimental Toxoplasma retinochoroiditis. Ophthalmologica. 2007;221:421–425.
   PubMed Web of Science ®Google Scholar
• Kaltenberg J, Plum LM, Ober-Blobaum JL, et al. Zinc signals promote IL-2-dependent proliferation of T cells. Eur J Immunol. 2010;40:1496–1503.
   PubMed Web of Science ®Google Scholar
• Prasad AS. Zinc in human health: effect of zinc on immune cells. Mol Med. 2008;14:353–357.
   PubMed Web of Science ®Google Scholar
• Lopez-Garcia DR, Gomez-Flores M, Arce-Mendoza AY, et al. Oral zinc sulfate for unresponsive cutaneous viral warts: too good to be true? A double-blind, randomized, placebo-controlled trial. Clin Exp Dermatol. 2009;34:e984–e985.
   PubMed Web of Science ®Google Scholar
• Mahmoudi H, Ghodsi SZ, Tavakolpour S, et al. Cryotherapy plus oral zinc sulfate versus cryotherapy plus placebo to treat common warts: a double blind, randomized, placebo-controlled trial. Int J Womens Dermatol. 2018;4:87–90.
   PubMedGoogle Scholar
• Al-Gurairi FT, Al-Waiz M, Sharquie KE. Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial. Br J Dermatol. 2002;146:423–431.
   PubMed Web of Science ®Google Scholar
• Yaghoobi R, Sadighha A, Baktash D. Evaluation of oral zinc sulfate effect on recalcitrant multiple viral warts: a randomized placebo-controlled clinical trial. J Am Acad Dermatol. 2009;60:706–708.
   PubMed Web of Science ®Google Scholar
• Puviani M, Manfredini M, Eisendle K. The SILVER study. Efficacy of topical nitric–zinc complex solution in the treatment of resistant warts: a postmarketing evaluation. Dermatol Ther. 2019;32:e12940.
   PubMed Web of Science ®Google Scholar
• Giacaman A, Granger C, Aladren S, et al. Use of topical nitric–zinc complex solution to treat palmoplantar and periungual warts in a pediatric population. Dermatol Ther (Heidelb). 2019;9:755–760.
   PubMed Web of Science ®Google Scholar
• Rozas-Munoz E, Mir-Bonafe J, Piquero-Casals J. Refractory warts successfully treated with a nitric–zinc complex solution. J Dermatol. 2019;46:e250–e251.
   PubMed Web of Science ®Google Scholar
• Shumer SM, O’Keefe EJ. Bleomycin in the treatment of recalcitrant warts. J Am Acad Dermatol. 1983;9:91–96.
   PubMed Web of Science ®Google Scholar
• Hayes ME, O'Keefe EJ. Reduced dose of bleomycin in the treatment of recalcitrant warts. J Am Acad Dermatol. 1986;15:1002–1006.
   PubMed Web of Science ®Google Scholar
• Manz LA, Pelachyk JM. Bleomycin–lidocaine mixture reduces pain of intralesional injection in the treatment of recalcitrant verrucae. J Am Acad Dermatol. 1991;25:524–526.
   PubMed Web of Science ®Google Scholar
• Dobson JS, Harland CC. Pulsed dye laser and intralesional bleomycin for the treatment of recalcitrant cutaneous warts. Lasers Surg Med. 2014;46:112–116.
   PubMed Web of Science ®Google Scholar
• Agius E, Mooney JM, Bezzina AC, et al. Dermojet delivery of bleomycin for the treatment of recalcitrant plantar warts. J Dermatolog Treat. 2006;17:112–116.
   PubMed Web of Science ®Google Scholar
• Gamil HD, Nasr MM, Khattab FM, et al. Combined therapy of plantar warts with topical bleomycin and microneedling: a comparative controlled study. J Dermatolog Treat. 2019;17:1–6.
   Google Scholar
• Konicke K, Olasz E. Successful treatment of recalcitrant plantar warts with bleomycin and microneedling. Dermatol Surg. 2016;42:1007–1008.
   PubMed Web of Science ®Google Scholar
• Sardana K, Garg V, Relhan V. Complete resolution of recalcitrant periungual/subungual wart with recovery of normal nail following “prick” method of administration of bleomycin 1%. Dermatol Ther. 2010;23:407–410.
   PubMed Web of Science ®Google Scholar
• Munn SE, Higgins E, Marshall M, et al. A new method of intralesional bleomycin therapy in the treatment of recalcitrant warts. Br J Dermatol. 1996;135:969–971.
   PubMed Web of Science ®Google Scholar
• Broganelli P, Chiaretta A, Fragnelli B, et al. Intralesional cidofovir for the treatment of multiple and recalcitrant cutaneous viral warts. Dermatol Ther. 2012;25:468–471.
   PubMed Web of Science ®Google Scholar
• Padilla Espana L, Del Boz J, Fernandez-Morano T, et al. Recalcitrant warts and topical cidofovir: predictive factors of good response. J Eur Acad Dermatol Venereol. 2016;30:1218–1220.
   PubMed Web of Science ®Google Scholar
• Gupta M, Bayliss SJ, Berk DR. Topical cidofovir for refractory verrucae in children. Pediatr Dermatol. 2013;30:131–134.
   PubMed Web of Science ®Google Scholar
• Hivnor C, Shepard JW, Shapiro MS, et al. Intravenous cidofovir for recalcitrant verruca vulgaris in the setting of HIV. Arch Dermatol. 2004;140:13–14.
   PubMedGoogle Scholar
• Henrickson SE, Treat JR. Topical cidofovir for recalcitrant verrucae in individuals with severe combined immunodeficiency after hematopoietic stem cell transplantation. Pediatr Dermatol. 2017;34:e24–e25.
   PubMed Web of Science ®Google Scholar
• Kralund HH, Broesby-Olsen S, Bistrup C, et al. Substantial effect of topical cidofovir 1% on recalcitrant warts in a renal-transplanted adolescent: a case report. Transplantation. 2011;91:e52–e54.
   PubMed Web of Science ®Google Scholar
• McAleer MA, Bourke J. Intravenous cidofovir for resistant cutaneous warts in a patient with psoriasis treated with monoclonal antibodies. Clin Exp Dermatol. 2011;36:638–640.
   PubMed Web of Science ®Google Scholar
• Grone D, Treudler R, de Villiers EM, et al. Intravenous cidofovir treatment for recalcitrant warts in the setting of a patient with myelodysplastic syndrome. J Eur Acad Dermatol Venerol. 2006;20:202–205.
   PubMed Web of Science ®Google Scholar
• Kottke MD, Parker SR. Intravenous cidofovir-induced resolution of disfiguring cutaneous human papillomavirus infection. J Am Acad Dermatol. 2006;55:533–536.
   PubMed Web of Science ®Google Scholar
• Cusack C, Fitzgerald D, Clayton TM, et al. Successful treatment of florid cutaneous warts with intravenous cidofovir in an 11-year-old girl. Pediatr Dermatol. 2008;25:387–389.
   PubMed Web of Science ®Google Scholar
• Joshipura D, Goldminz A, Greb J, et al. Acitretin for the treatment of recalcitrant plantar warts. Dermatol Online J. 2017;23.
   Google Scholar
• Choi YL, Lee KJ, Kim WS, et al. Treatment of extensive and recalcitrant viral warts with acitretin. Int J Dermatol. 2006;45:480–482.
   PubMed Web of Science ®Google Scholar
• El-Khayat RH, Hague JS. Use of acitretin in the treatment of resistant viral warts. J Dermatolog Treat. 2011;22:194–196.
   PubMed Web of Science ®Google Scholar
• Katz RA. Isotretinoin treatment of recalcitrant warts in an immunosuppressed man. Arch Dermatol. 1986;122:19–20.
   PubMedGoogle Scholar
• Monastirli A, Matsouka P, Pasmatzi E, et al. Complete remission of recalcitrant viral warts under oral isotretinoin in a patient with low-grade B-cell lymphoma. Acta Derm Venereol. 2005;85:358–360.
   PubMed Web of Science ®Google Scholar
• Herold M, Nielson C, Longo MI. Isotretinoin and candida immunotherapy for recalcitrant warts in solid organ transplant recipients. Dermatol Ther. 2019;32:e12803.
   PubMed Web of Science ®Google Scholar
• Olguin-Garcia MG, Jurado-Santa Cruz F, Peralta-Pedrero ML, et al. A double-blind, randomized, placebo-controlled trial of oral isotretinoin in the treatment of recalcitrant facial flat warts. J Dermatolog Treat. 2015;26:78–82.
   PubMed Web of Science ®Google Scholar