Can the HPV vaccine treat verrucae and warts (2025 Update)?

This is not a new question for me on my blog but in the four years since I last posted about it here. I thought it was timely for a revisit.

Can the HPV vaccine effectively treat warts on the skin?

The HPV vaccination programme was introduced into the UK for girls in September 2008, and for boys since 2019 with over 10 million vaccinations being administered in the UK since that time (UK Government data). The vaccination programme was developed to reduce cases of cervical, anogenital and oropharyngeal malignancies. Guidance from research has shown it is most effective when given to children before they become sexually active [1]. Consequently, Cancer Research UK data has shown rates of cervical cancer are expected to be slashed by 90% in those vaccinated early with an expected drop of up to 96% in all anal cancers with the newer non-valent vaccines which provide coverage against 9 known oncogenic strains of the HPV virus [2].

How do they work against cutaneous warts?

To date there has been little discussion on how they may work for cutaneous warts and verrucae. One theory suggests that there is some similarity in the genomes of HPV 2 (cutaneous warts) and HPV (a cause of genital warts which may lead to cross reactivity [5].

Review of HPV vaccine in wart prevention and treatment

When it was first introduced there was hope that some cross protection would occur and there would be a decrease the rates of cutaneous warts, even though they are caused by different, non-oncogenic strains not covered by the vaccines. In my previous blog, I discussed a study where after three vaccinations over 6 months a clearance of cutaneous warts of 62% was observed [3]. In a forthcoming paper published in the Journal of the American Academy of Dermatology, researchers undertake a clinical review of the HPV vaccine in the prevention and treatment of warts [4]. The paper examines treatment of anogenital and cutaneous warts (HPV 1,2 and 4 strains) which are responsible for a significant proportion of hand and foot warts.

The research reviewed the available evidence, identifying 11 studies investigating the use HPV vaccines in cutaneous wart treatment (2019 - 2024). The majority were descriptive (non-experimental) studies (n=7) with the remainder being one randomised controlled study (n=1), controlled studies without randomisation (n=2) and an experimental study (n=1).

What are the authors recommendations?

1. The authors of the review do not recommend intramuscular HPV vaccination for preventing cutaneous (common and plantar) warts.

2. The authors similarly do not recommend intramuscular infection of HPV vaccine for the treatment of warts.

3. The authors conditionally do not recommend the use of intralesional HPV vaccination to treat common and plantar lesions.

4. Where patients have failed multiple treatments, intralesional or intramuscular vaccination may offer faster resolution where multiple therapies have failed.

5. The authors do not recommend HPV vaccination as a treatment for cutaneous warts in children, the immunosuppressed or during pregnancy.

Implications for practice

The review has demonstrated that there is a lack of evidence to guide clinicians’ decisions for treating cutaneous and plantar warts with HPV vaccine. On the issue of preventing cutaneous warts, the true value of the vaccine is not known from the available data. However, this would be a difficult study to design. Moreover, real world data based on HPV vaccination rates globally has not led to any indications suggesting the cutaneous warts and verrucae are any less common now than before 2008 when the vaccination process began.

Whilst there is a suggestion that the vaccine could be used in recalcitrant cases, it may be considered a third line treatment as many other, well studied options exist already. However, it is important to stress that the use of the HPV vaccine in the UK and USA remains as an off-licence use, as they are indicated for prophylactic use to prevent cancer – not to prevent or treat cutaneous warts. Currently these recommendations are not part of any published guidelines in the UK.

References

1. Ellingson, M.K., et al., Human papillomavirus vaccine effectiveness by age at vaccination: A systematic review. Hum Vaccin Immunother, 2023. 19(2): p. 2239085.

2. Patel, C., et al., The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? Euro surveillance : bulletin Europeen sur les maladies transmissibles. European communicable disease bulletin, 2018. 23(41): p. 1700737.

3. Shin, J.-O., et al., Nonavalent human papilloma virus vaccine for the treatment of multiple recalcitrant warts: an open label study. Journal of the American Academy of Dermatology, 2021.

4. Ong, M.M., et al., Human papillomavirus vaccine for the prevention and treatment of warts: A clinical review. JAAD Reviews, 2025. 6: p. 12–22.

5. Smith, S.P., H.E. Baxendale, and J.C. Sterling, Clearance of recalcitrant warts in a patient with idiopathic immune deficiency following administration of the quadrivalent human papillomavirus vaccine. Clinical and Experimental Dermatology, 2017. 42(3): p. 306–308.