Unveiling the potential of intralesional acyclovir in managing cutaneous warts

Objectives: Managing cutaneous warts caused by human papillomavirus (HPV) remains challenging, with existing treatments often limited by high recurrence and variable efficacy. Given the viral origin of warts and the proven efficacy of acyclovir against DNA viruses, it may offer a novel therapeutic approach for targeting HPV. This study aimed to evaluate the efficacy and safety of intralesional acyclovir in the management of cutaneous warts. Material and Methods: After institutional ethics committee approval, a single-arm prospective interventional study was conducted at a tertiary care hospital. After recording demographic and clinical history, patients were treated with intralesional acyclovir (70 mg/mL) every 2 weeks until wart clearance or a maximum of five sessions. Clinical photographs were taken at each visit to assess treatment response, and side effects were recorded. Data were analyzed using appropriate statistical tests. Results: Out of the 45 patients who completed the study, complete wart clearance was achieved in 73.33% ( n = 33), while partial and no response were observed in 22.22% ( n = 10) and 4.44% ( n = 2), respectively. The highest clearance rate was seen in plantar warts (84.62%), followed by 77.78% in palmar warts and 40% in common warts, with periungual warts showing partial resolution. Side effects were reported in 66.67% ( n = 30), with hemorrhagic eschar (56.67%, n = 17) and blister formation (43.33%, n = 13) being the most common. Conclusion: Intralesional acyclovir, with its potential to directly target HPV, represents a promising, safe, and effective new approach in the armamentarium for the treatment of warts.