Efficacy of intralesional methotrexate in the treatment of plantar warts

Abstract

Warts are tumors or growths caused by infection with human papilloma virus (HPV). Currently, over 170 HPV types have been identified. This study aimed to evaluate the efficacy and safety of intralesional injection of methotrexate (MTX) for the treatment of plantar warts. Sixty patients presented with plantar warts were divided into two groups. Group A patients were injected with intralesional MTX (2 mg/ml). Group B patients were injected with intralesional saline as a placebo. The injections were repeated every week for a maximum of six sessions or until complete clearance, whichever was earlier. The patients were followed up for 6 months after the last injection. In the intralesional MTX group, 2 patients (6.7%) showed complete improvement, 8 patients (26.7%) showed partial improvement, and 20 patients (66.7%) showed no improvement. In the intralesional saline group, 3 patients (10%) showed complete improvement, 4 patients (13.3%) showed partial improvement, and 23 patients (76.7%) showed no improvement. Reported adverse events were local reactions in the form of swelling, pain, and infection in both groups. There was no statistically significant difference between the therapeutic responses to intralesional MTX injection and saline.

Intralesional methotrexate in dermatology: Diverse indications and practical considerations

“…Viral warts are benign lesions of the skin caused by human papillomavirus and can prove resistant to treatment. 39 MTX was found to have an anti-viral effect in cells infected with Zikavirus possibly through inhibition of dihydrofolate reductase. 40 It is plausible that MTX could act on viral warts in a similar manner (Table 4).…”

“…40 It is plausible that MTX could act on viral warts in a similar manner (Table 4). 39 In a randomized controlled trial (n = 60), patients were split into IL-MTX (2 mg/ml) vs saline injections as placebo. 39 Injections were given every week for a maximum of six treatments.…”

“…39 In a randomized controlled trial (n = 60), patients were split into IL-MTX (2 mg/ml) vs saline injections as placebo. 39 Injections were given every week for a maximum of six treatments. There was no statistically significant difference in response.…”