Nongenital warts affect 7–10%1 of the general population and are a common dermatological condition in general practice. Human papilloma virus (HPV) is the causative agent, which enters via breaches in the skin surface and infects keratinocytes, resulting in metaplasia and excessive skin growth. There are multiple subtypes of HPV, depending on anatomical site and morphology. Subtypes 1, 2, 4, 27 and 57 lead to common warts on the hands and feet; whereas subtypes 3 and 10 give rise to planar warts on the hands and face.2 Left alone, two-thirds of nongenital common warts will resolve spontaneously.3 However, some do not resolve despite repeated treatment, these are referred to as ‘recalcitrant warts’.
Nongenital warts are a common presentation in general practice. Despite treatment
according to evidence based guidelines, a significant proportion of common warts fail
to resolve, becoming recalcitrant. This poses a problem in clinical management. The
recommendations for treating recalcitrant warts are unclear and there is a wide range of
second line treatments available. This article reviews the available methods of treatment
for recalcitrant nongenital warts as described in the medical literature.
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