Safety Evaluation of Therapeutic Interventions for Plantar Warts (Kapasi): Psychodermatology, Stress-Mediated Immunity, and Regulatory Considerations

Currently, there are more than 3 million people worldwide suffering from plantar warts (Kapsi). Possible ways of treatment include keratolytics, cryosurgery, lasers, and intralesional immunotherapy. However, many factors, including the high rate of treatment failure, local regulations, safety concerns, and self-medicating practices, complicate these methods. Some studies indicate that psychosocial stress may worsen the effect of therapy in the case of viral infections by decreasing immune function via the action of cortisol, thus contributing to increased susceptibility to HPV (Human Papillomavirus) infection and persistent lesions. Nevertheless, despite all these observations, the role of psychology in drug therapy remains underestimated in this area. This literature review integrates the perspectives of dermatologists, immunologists, psychoneuroendocrinologists, and specialists in pharmacovigilance. The analysis focuses on currently popular treatments, including nitric oxide patches, vitamin D3 injections, immunization based on the MMR vaccine, nanoparticle-based drugs, as well as off-label use of various acids, among others. Special attention is paid to the potential toxicity, safety, efficiency, regulatory approval, and risks of self-treatment. In addition, issues of chemical burns from uncontrolled wart medications, the need to improve post-marketing monitoring of safety, and the danger of HPV infection associated with laser treatment are covered. Some of the key gaps related to plantar wart treatment include a lack of psychodermatology protocols for managing patients with mental stress, inadequate prediction of the effectiveness of treatment in such cases, different OTC treatment regulations, and insufficient knowledge concerning the risks associated with immunotherapies. Possible future improvements include better regulation of medications, novel and safe treatments, and the development of artificial intelligence monitoring and adaptation systems.