The use of American Pawpaw (Asimina triloba) for the treatment of warts is primarily based on traditional and folk medicine practices rather than robust scientific validation. In various parts of North America, extracts from pawpaw, especially from the bark, twigs, or fruit, have been employed in topical preparations to address skin ailments, including warts. This traditional use is likely due to the presence of natural compounds called acetogenins in pawpaw, which exhibit cytotoxic properties and have been studied for their potential to inhibit the growth of certain cells, including cancerous cells.

However, clinical evidence supporting the efficacy of pawpaw extracts specifically for wart removal is limited and largely anecdotal. A few preliminary studies, including some investigating pawpaw extract-based commercial products, suggest possible effectiveness but are generally small, poorly controlled, or not peer-reviewed. No large-scale randomized controlled trials have been conducted to substantiate these claims. The U.S. Food and Drug Administration (FDA) does not recognize pawpaw as an approved treatment for warts.

In summary, the use of pawpaw for warts is supported by traditional use and some theoretical rationale based on its phytochemistry, but lacks strong scientific evidence, warranting a low evidence rating.