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

Br J Dermatol. 2018 Jan;178(1):253-260. doi: 10.1111/bjd.15758. Epub 2017 Dec 14.


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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Acetates / therapeutic use
  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Child
  • Child, Preschool
  • Cryotherapy / methods
  • Female
  • Foot Dermatoses / genetics
  • Foot Dermatoses / pathology
  • Genotype
  • Humans
  • Male
  • Middle Aged
  • Papillomaviridae / genetics*
  • Retrospective Studies
  • Salicylic Acid / therapeutic use
  • Skin Diseases, Viral / genetics*
  • Skin Diseases, Viral / pathology
  • Skin Diseases, Viral / therapy
  • Treatment Outcome
  • Warts / genetics*
  • Warts / pathology
  • Warts / therapy
  • Young Adult


  • Acetates
  • Antiviral Agents
  • chloroacetic acid
  • Salicylic Acid