Therapies for non-anogenital cutaneous warts in immunocompromised patients: A systematic review

Summary: Abstract Body: The immune system plays a key role in host recognition and clearance of human papillomavirus-driven cutaneous warts. In immunocompromised patients, warts may be difficult to manage or recalcitrant to first line therapies, raising the risk of progression or malignant transformation. While many interventions exist, there is a lack of comprehensive data on the selection and efficacy of treatments in this patient population. We conducted a systematic review of PubMed, MEDLINE, Web of Science, Scopus, and Cochrane with relevant search parameters for articles published from 1999 to 2024. Of 2,233 articles screened, 46 met the inclusion criteria, with 114 adult and pediatric patients. Among these were 35 case reports, six case series, two retrospective cohort studies, one retrospective observational study, one prospective cohort study, and one open-label clinical trial. The most common immunocompromising condition was organ transplant (58%, n=66), and the least common was iatrogenic immunosuppression (2%, n=2). The most frequent previously failed treatments prior to receiving the studied intervention were cryotherapy, salicylic acid, imiquimod, and 5-fluorouracil. Topical cidofovir exhibited the best response, with 100% complete response (n=7). Pulsed dye laser therapy (PDL), the most frequently studied, showed moderate efficacy (59% partial response, 41% complete response, n=17). Imiquimod had the lowest efficacy (64% no response, 36% partial response, n=14). PDL had the fastest time to clearance at 0.27 months (n=1). Cimetidine had the highest recurrence rate of 29% (n=8). Adverse effects were minimal and did not alter course of treatment. Our review comprehensively synthesizes the existing data over the last 25 years. While several treatments are available, evidence supporting their efficacy remains limited due to small sample sizes and case numbers. Future research directly comparing treatment modalities could help further define the most effective interventions for these challenging lesions. Daniel Jeong¹, Vaibhav Garg², Abdulaziz Alhussein², Stephanie Jackson Cullison² 1. Drexel University College of Medicine, Philadelphia, PA, United States. 2. Thomas Jefferson University, Philadelphia, PA, United States. Clinical Research: Interventional Research