Morphological characteristics and human papillomavirus genotype predict the treatment response in cutaneous warts. (1st January 2018)

• Record Type: Journal Article
• Authors: Hogendoorn, G.K.; Bruggink, S.C.; de Koning, M.N.C.; Eekhof, J.A.H.; Hermans, K.E.; Rissmann, R.; Burggraaf, J.; Wolterbeek, R.; Quint, K.D.; Kouwenhoven, S.T.P.; Bouwes Bavinck, J.N.
• Is Part Of: British journal of dermatology. Volume 178:Number 1(2018)
• Page Start: 253
• Page End: 260
• Publication Date: 2018-01-01
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.15758
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Cutaneous warts have a cure rate after therapy of no more than approximately 50%. Recently, we developed and validated a standard assessment tool for warts (Cutaneous WARTS diagnostic tool, CWARTS) based on phenotypical characteristics. Objectives: To assess whether patient and morphological wart characteristics predict the human papillomavirus (HPV) type in a specific wart and whether these characteristics as well as the HPV type predict a favourable treatment response. Methods: Photographs were used to score nine morphological wart characteristics using the newly developed CWARTS tool. Genotyping of 23 wart‐associated HPV types was performed using the hyperkeratotic skin lesion–polymerase chain reaction/multiplex genotyping assay. The results were correlated with a favourable response to treatment with monochloroacetic acid, cryotherapy or a combination of cryotherapy and salicylic acid. Odds ratios were calculated using logistic regression in a generalized estimating equations model. Results: Black dots (capillary thrombosis) strongly predicted the presence of any HPV type in a wart. From all characteristics tested, the HPV type most strongly predicted the treatment response when the warts were treated with monochloroacetic acid or a combination of cryotherapy and salicylic acid with a significantly decreased treatment response if the warts contained HPVs of the alpha genus (HPV2, HPV27 or HPV57). When cryotherapy alone was used for common warts, HPV type did not play a role, but cryotherapy was less effective in the presence of callus and when the wart was located deeper in the skin. Conclusions: Morphological characteristics of the warts and the HPV genotype influence treatment outcome and thus potentially influence future treatment decisions for common and plantar warts.