Background: Recalcitrant cutaneous warts are commonly encountered indermatology outpatient clinics. Little is known about the causes of recalcitrance totherapy of cutaneous warts. Essential trace elements are vital to proper immunefunction, including zinc and selenium. Although nickel is an essential traceelement, its excess is immunotoxic. Trace elements measured in human toenailsreflect a time-integrated exposure and intake of elements over several months.Objective: Quantitative measurement of zinc, selenium and nickel in toenails ofEgyptian patients with recalcitrant warts in comparison to apparently healthymatching controls.Methods: Toenail samples were collected from 28 patients with recalcitrant wartsand 30 matching controls. Analysis of zinc, selenium and nickel concentrations intoenail samples was carried out using a Prodigy High Dispersion InductivelyCoupled Plasma- Optical Emission Spectroscopy (Teledyne Leeman Labs, USA).Results: The mean toe nail selenium concentration showed a statisticallysignificant higher value in patient group in comparison to control group (0.74±1.00μg/g versus 0.34±0.48 μg/g respectively; p= 0.03). There was no statisticallysignificant difference between patient and control groups as regards the mean zincand nickel toe nail concentrations. The mean toe nail zinc concentration in theiipatient and control groups was 96.39±40.80 μg/g versus 108.52±65.88 μg/grespectively (p= 0.57), while the mean toe nail nickel concentration was21.92±18.06 μg/g versus 20.61±16.69 μg/g respectively (p=0.72). Limitations: small sample size.Conclusions: Egyptian patients with recalcitrant warts do not show abnormaltoenail zinc concentrations in comparison to matching controls. However, they doshow significantly higher concentrations of selenium, which raises doubts aboutthe protective role of selenium against HPV infection. Both patients and controlsshowed extremely high nickel concentrations, with no statistical difference inbetween.