Abstract
<jats:p>Background Benign HPV-related warts of the head and neck are common lesions in children, adolescents, and young adults. Despite their non-malignant nature, their visibility, persistence, and recurrence result in a significant cosmetic and psychosocial burden. Management in this anatomically sensitive region requires balancing clinical effectiveness with preservation of cosmetic outcomes. Available evidence is heterogeneous and frequently not specific to the head and neck, as many studies combine different anatomical sites and lesion types. Aims To critically evaluate current treatment options for benign HPV-induced warts of the head and neck, with emphasis on the balance between clinical effectiveness and cosmetic safety, and to compare minimally invasive and destructive approaches in terms of recurrence, safety, and cosmetic outcomes. Methods A narrative review with a structured literature search was conducted using PubMed, PubMed Central, and Google Scholar. ResearchGate was used as an additional source. The search covered publications from 2015 to November 2026 and was limited to English-language studies. Eligible publications included meta-analyses, systematic reviews, randomized controlled trials, observational studies, and clinical guidelines. Study selection and data extraction were performed by two reviewers. A total of 42 studies were included in the qualitative synthesis. Results No single treatment modality was identified as universally superior. Destructive methods demonstrate high clearance rates but are associated with a higher risk of pain, scarring, pigmentary changes, and recurrence, which limits their use in cosmetically sensitive areas. Minimally invasive approaches, particularly laser-based therapies, show high effectiveness, with reported clearance rates of approximately 70 to 90 percent, and more favorable cosmetic outcomes. Intralesional immunotherapy demonstrates variable effectiveness, ranging from 23 to 95 percent, reflecting differences in agents, treatment protocols, and study populations, and may enable clearance of both treated and distant lesions with minimal risk of scarring. Topical and systemic therapies show moderate effectiveness but require prolonged treatment and high patient adherence. Evidence on HPV vaccination suggests a possible therapeutic effect, although current data remain limited and heterogeneous. Conclusions Management of benign HPV warts of the head and neck requires an individualized approach. In relation to the research questions, minimally invasive methods and immunotherapy, in selected clinical contexts, may provide a more favorable balance between effectiveness and cosmetic safety compared to destructive approaches, while destructive methods remain appropriate in selected cases. The lack of head-and-neck-specific data, heterogeneity of study designs, and limited long-term follow-up restrict the strength of conclusions and do not allow the development of standardized treatment algorithms. Further high-quality studies with standardized outcomes are required.</jats:p>