Abstract Back ground Recalcitrant planter warts are representing a therapeutic challenge. Intralesional cryotherapy (ILC) has emerged as a promising therapeutic option in recalcitrant planter warts treatment. Objective To compare the clinical efficacy and tolerability of (ILC) versus Cryotherapy spray (Cryo-sp) for treatment of recalcitrant plantar warts. Methods One hundred-thirty patients with recalcitrant plantar warts were assigned equally to two groups. Group A received ILC and group B treated with Cryo-SP. Both groups received one session at 2 weeks intervals until complete clearance or for a maximum of 5 sessions. Main outcome was complete clearance of the warts guided by dermoscopy. Follow-up was carried out for 6 months after the treatment. Results Complete clearance occurred in 80.3% in group A compared to 50.8% in group B with a highly significant difference between both groups (P<0.001). The clearance rate was faster in group A (1.5 ±0.40) than group B (4± 1.3) (p<0.001). The adverse effects were mild in group A than group B (P<0.001). The recurrence rate was 2 % in group A versus 23.3% in group B (P<0.007).patients satisfaction was higher in ILC (P<0.001). Conclusion Intralesional cryotherapy is more effective, requiring few sessions with low recurrence rate than cryo-sp.