Morphological characteristics and human papillomavirus genotype predict the treatment response in cutaneous warts

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. What's already known about this topic? Cutaneous warts are a major health concern because of their high prevalence. Although there are multiple treatment options, cure rate after therapy is no more than approximately 50%. What does this study add? Predictive characteristics of warts are identified that will improve decision making regarding therapeutic options. Linked Comment: Silling and Akgül. Br J Dermatol 2018; 178:30–31. Plain language summary available online Respond to this article