Plantar warts continue to represent a therapeutic challenge due to treatment resistance and high recurrence rates. Intralesional methotrexate, a cytotoxic chemotherapeutic agent with in-vitro anti-viral properties has been used for many dermatological indications. Two previous studies evaluated intralesional injection of diluted methotrexate (in 0.5, 1, and 2 mg/ml dilutions) in the treatment of warts and found it poorly effective.The concentrations used in these studies were much lower than those used for other indications. The current, open-label, prospective, pilot study aimed to evaluate the safety and efficacy of the intralesional injection of full concentration (25 mg/ml) methotrexate in the treatment of plantar warts. Twenty patients with plantar warts, 10 (50%) males, and 10 (50%) females, with mean ± SD age of 28.45 ± 8.66 years (range, 18-46 years) received biweekly sessions of intralesional methotrexate (25 mg/ml) until complete clearance or for a maximum of 6 sessions. Complete clearance of warts was achieved in 2 (10%), 6 (30%), and 7 (35%) patients after 4, 5, and 6 sessions, respectively. Another 8 (40%) patients showed partial improvement after 6 sessions. The response rate did not correlate significantly with the number of warts. Nine (45%) patients did not report any side effects. Pain and bruises were reported by 8 (40%) and 6 (30%) patients, respectively. These findings suggest that biweekly sessions of full (25 mg/ml) concentration of methotrexate are a safe and effective treatment for plantar warts. It may be considered an alternative line of treatment for resistant cases.

Background: Warts are benign skin lesions that occur as a result of infection with human papillomavirus (HPV). Warts are classified according to their sites and shapes as (i) Common wart; (ii) Plantar wart; (iii) Plane wart and (iv) Genital wart (condyloma accuminatum). The type of wart present on the plantar surface of the foot is called planter wart and there are various types of HPV have been identified to cause planter warts including HPV-1, -2, -3, -4, -27, -29, -57, -60, -63, -65, -66, and -69. It has been already established that radical treatment of warts is often challenging for both the physician and the patient. Aim of the study: To assess the effectiveness of Intralesional Methotrexate in comparison with 5-Flurouracil in treatment of Plantar Warts. Patients and Methods: The study was carried out on 40 patients with planter warts. Two groups of patients were obtained. Group A included 20 patients were injected MTX in full concentration into the base of the wart and Group (B) included 20 patients were injected intralesional 5 Fluorouracil in full concentration.Results: There is a significant difference between the two groups as regard the response (Group B -5-FU group-is more effective) with no statistical significant difference between the 2 groups as regard the type, number, duration of warts or the complications of injection. Conclusion: MTX is less effective than 5-FU in treating plantar warts.