Gaps in practice

January/February 2011

Recalcitrant nongenital warts

Volume 40, No.1, January/February 2011 Pages 40-42

Lawrence Leung

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.

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’.

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