Morphological characteristics and HPV genotype predict the treatment response in cutaneous warts

Abstract

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 (CWARTS) based on phenotypical characteristics.

Objectives

To assess whether patient and morphological wart characteristics predict the HPV type in the specific wart and whether these characteristics as well as the HPV type predict a favourable treatment response.

Methods

Photographs were used to score 9 morphological wart characteristics using the newly developed CWARTS tool. Genotyping of 23 wart-associated HPV types was performed using the HSL-PCR/MPG 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 Generalised Estimating Equations (GEE) 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 the combination of cryotherapy and salicylic acid with a significantly decreased treatment response if the warts contained HPVs of the alpha genus (HPV2, HPV27 or HPV 57). When cryotherapy alone was used for common warts, HPV type did not play a role, but cryotherapy was less effective when the wart showed callus and 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.

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