Efficacy and Safety of Oral Isotretinoin in Plane Warts: A Systematic Review on Clinical Studies

Abstract

BackgroundHuman papillomavirus-induced plane warts represent benign cutaneous lesions that, despite frequent spontaneous resolution, demonstrate persistence and recurrence patterns associated with considerable cosmetic and psychological morbidity. Isotretinoin has emerged as a therapeutic consideration for recalcitrant plane warts. We evaluated isotretinoin effectiveness and safety in the management of plane warts through a systematic analysis of available clinical evidence.MethodsWe conducted this systematic review following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, with prospective registration in PROSPERO (ID: CRD420251060689). Comprehensive searches of PubMed, Scopus, and EMBASE databases were extended through November 2024. Primary efficacy outcomes focused on isotretinoin-induced changes in wart lesion characteristics.ResultsFifteen studies met the inclusion criteria, comprising six clinical trials, one cross-sectional study, six case reports, and two case series conducted across seven countries, encompassing 438 patients. Complete resolution rates demonstrated substantial variation, ranging from 38 to 87.5. Among 10 studies documenting adverse events, cheilitis and dry skin emerged as the most common side effects.ConclusionOral isotretinoin shows promise for recalcitrant plane warts, but current evidence is heterogeneous and largely of moderate-to-low quality. These findings are insufficient to support routine clinical use at this time; well-designed, adequately powered randomized controlled trials with standardized dosing and outcomes are needed.