INTRODUCTION
Plantar warts are hyperkeratotic lesions arising on the sole of the foot that result from infection with human papillomavirus (HPV), most commonly types 1, 2, 27, or 57.1,2 Plantar warts demonstrated a 14% incidence rate for children in one study, and accounted for 40% of cutaneous warts in another study of college students.3,4 These viral lesions are notoriously recalcitrant in nature, with high recurrence rates and the potential to impair ambulation.5
Plantar warts are commonly treated with cryotherapy and/or keratolytic agents.6 However, given their recalcitrant nature and the lack of information regarding expected clinical efficacy, other therapies such as immunotherapy, antiproliferative agents, and even non-conventional treatments (ie, duct tape, smoke exposure, surgical excision) are often used.6,7
In 2012, a systematic review noted a lower treatment response rate for plantar warts compared with cutaneous warts at other anatomic sites, calling for high-quality research focused on the former.6 Recently, several novel intralesional therapies for plantar warts have emerged, including vitamin D3, zinc sulfate, and purified protein derivate (PPD).5,8,9 Therefore, we highlight dynamic updates on intralesional plantar wart treatments in the past decade, to provide practicing clinicians with a deeper understanding given the lack of consensus regarding optimal plantar wart treatment.6
Plantar warts are commonly treated with cryotherapy and/or keratolytic agents.6 However, given their recalcitrant nature and the lack of information regarding expected clinical efficacy, other therapies such as immunotherapy, antiproliferative agents, and even non-conventional treatments (ie, duct tape, smoke exposure, surgical excision) are often used.6,7
In 2012, a systematic review noted a lower treatment response rate for plantar warts compared with cutaneous warts at other anatomic sites, calling for high-quality research focused on the former.6 Recently, several novel intralesional therapies for plantar warts have emerged, including vitamin D3, zinc sulfate, and purified protein derivate (PPD).5,8,9 Therefore, we highlight dynamic updates on intralesional plantar wart treatments in the past decade, to provide practicing clinicians with a deeper understanding given the lack of consensus regarding optimal plantar wart treatment.6
MATERIALS AND METHODS
A primary literature search was conducted using the PubMed/MEDLINE bibliographical database with the following search terms: "plantar warts" OR "verruca plantaris" AND "treatment", according to PRISMA reporting guidelines for systematic reviews.10 There were 569 total articles in the initial search, with 13 duplicate articles and one article found as a reference in another study. Peer-reviewed articles, conducted in human subjects, written in English, and published from January 2012 to January 2021 were considered for inclusion if they provided primary data on safety/efficacy of an intralesional therapy for plantar wart(s). Articles addressing multiple wart types were eligible for full-text review if plantar, foot, and/or pedal warts were mentioned in the title and/or abstract. Exclusion criteria included all basic science articles, reviews, study protocols, and editorials/commentaries. One study was excluded following full-text review as it did not report either the number of plantar wart subjects or the number of treated plantar warts (Figure 1). Quality of evidence assessment was conducted using a modified version of the 2011 Oxford Centre for Evidence-Based Medicine Scheme.11
