What treatment modalities have you had success with for treating recalcitrant warts?

More than digital warts, I find plantar warts challenging to treat. This is my usual approach:

1. Paring down warts on feet.
2. Multiple rounds of cryotherapy every 4-6 weeks.
3. Between cryotherapy sessions- use of topical 5-FU with 40-70% salicylic acid
4. After 3 rounds of cryo- if still persistent- IL Cand...

Compounded topical Cidofovir 1% has been great for some of my most stubborn warts, you can get it compounded, for example at Low Cost pharmacy in Noblesville, IN.

Cook et al., PMID 37801536

Intralesional cidofovir works wonderfully and is now my go-to after failing cryotherapy.

Anshelevich et al., PMID 32348821

Could try Duct Tape since safe and easy. Other topical irritants may work as well. Topical sensitizers may also be useful with prolonged persistent warts.

Have not used cidofovir, highly interested in trying this as it seems to be a novel MOA.

Have used IL Candin for many years but did not ultimately feel it was worth the extra effort and patient discomfort. I rarely use it now.

Generally, I recommend HPV vaccine, and especially in recalcitrant warts,...