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

## TL;DR

This review assesses the effectiveness and safety of isotretinoin for treating persistent plane warts, finding mixed results and calling for better clinical trials.

## Contribution

The study systematically evaluates isotretinoin's role in treating plane warts, highlighting the need for higher-quality research.

## Key findings

- Complete resolution rates of plane warts with isotretinoin ranged from 38% to 87.5%.
- Cheilitis and dry skin were the most commonly reported adverse events.
- Current evidence is insufficient to support routine clinical use of isotretinoin for plane warts.

## Abstract

Human 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.

We 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.

Fifteen 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.

Oral 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.