# Combined surgical excision with skin grafting and thermal therapy for refractory plantar warts: a therapeutic approach in immunocompromised patients

## TL;DR

A combination of surgery, skin grafting, and heat therapy successfully treated persistent plantar warts in an immunocompromised patient.

## Contribution

A novel therapeutic approach combining excision, grafting, and thermal therapy for refractory warts in immunocompromised individuals.

## Key findings

- Radical excision and grafting resolved warts with no recurrence after six months.
- Adjunctive hyperthermia improved healing and prevented pain and mobility issues.
- This approach may offer durable remission in high-risk patients with treatment-resistant warts.

## Abstract

Refractory cutaneous viral warts in the immunocompromised carry a high risk of recurrence and malignant change. Evidence for effective treatment is scarce. A 54-year-old woman with systemic lupus erythematosus, steroid-induced diabetes, and multiple comorbidities presented with plantar warts resistant to topical agents, cryotherapy and laser therapy for a decade. Progressive ulceration, pain, and impaired gait made surgery unavoidable. Histology confirmed benign verrucous change. Two-stage management comprised radical excision and negative-pressure wound therapy, followed by split-thickness grafting. On healing, daily 44°C foot soaks for 30 min were prescribed. At 6 months, warts had resolved, pain ceased, mobility returned and there was no recurrence. Radical excision, immediate grafting and adjunctive hyperthermia delivered durable remission in this high-risk patient. This regimen warrants prospective comparison with conventional treatments in immunocompromised patients with recalcitrant warts.