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

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.