Developing and validating the Cutaneous WARTS (CWARTS) diagnostic tool: a novel clinical assessment and classification system for cutaneous warts. (18th December 2017)

• Record Type: Journal Article
• Authors: Hogendoorn, G.K.; Bruggink, S.C.; Hermans, K.E.; Kouwenhoven, S.T.P.; Quint, K.D.; Wolterbeek, R.; Eekhof, J.A.H.; de Koning, M.N.C.; Rissmann, R.; Burggraaf, J.; Bouwes Bavinck, J.N.
• Is Part Of: British journal of dermatology. Volume 178:Number 2(2018)
• Page Start: 527
• Page End: 534
• Publication Date: 2017-12-18
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.15999
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background : The clinical appearance of cutaneous warts is highly variable and not standardized. Objectives : To develop and validate a reproducible clinical tool for the standardized assessment of cutaneous warts to distinguish these lesions accurately. Methods : Nine morphological characteristics were defined and validated regarding intra‐ and interobserver agreement. Based on literature and semistructured interviews, a systematic dichotomous assessment tool, the Cutaneous WARTS (CWARTS) diagnostic tool was developed. The validation consisted of two independent parts performed with photographs from the recent WARTS‐2 trial. In part A, the CWARTS diagnostic tool was tested by 28 experienced physicians who assessed photographs of 10 different warts to investigate interobserver concordance. In part B, morphological characteristics were validated by masked and independent scoring of 299 photographs by six different observers. Part B also entailed reassessment of the photographs after at least 1 week. The primary outcome measurement was the intraclass correlation coefficient (ICC). Results : Presence of black dots (capillary thrombosis) had the greatest ICC (0·85) for interobserver agreement in part A, followed by arrangement (0·65), presence of border erythema (0·64) and sharpness of the border (0·60). In part B, results were similar for interobserver agreement with presence of black dots having the highest ICC (0·68), followed by border erythema (0·64), arrangement (0·58) and colour (0·55). For intraobserver agreement, presence of black dots had the highest agreement (0·70), followed by presence of border erythema (0·694) and colour (0·59). Conclusions : Wart phenotype can be reliably assessed using the CWARTS diagnostic tool. Abstract : What's already known about this topic? Cutaneous warts are a major public health concern because of their high prevalence, recurrence and only moderately effective treatment options. Warts are characterized by a wide spectrum of morphological features. What does this study add? Improved agreement among healthcare providers on the definition of warts and clinical classification was established. This study introduces and validates the Cutaneous WARTS (CWARTS) diagnostic tool, a new clinical diagnostic tool for warts. The CWARTS diagnostic tool will improve head‐to‐head comparisons of alternative treatment strategies in future studies. Linked Comment: Micali and Lacarrubba. Br J Dermatol 2018;178 :330 . Plain language summary available online Respond to this article