Introduction
wart, ®, verruca plantaris, infection of the skin with human papillomavirus, skin lesions
SKIN, WART, VIRUS, VERRUCA PLANTARIS, DISEASE, WARTS, VERRUCA VULGARIS, SKIN LESIONS
Cutaneous warts are benign skin lesions caused by the human papillomavirus (HPV). Even though they are considered benign, they can have a considerable impact on the quality of life and cause serious illness in certain immunocompromised populations. Studies have shown that the efficacy of wart treatment is dependent on the causative HPV type. Therefore, in this article, we aim to determine the HPV genotype-specific prevalence in cutaneous warts of a Flemish population as part of the Omnivirol-Salycilic acid randomized controlled trial. Swab samples of cutaneous warts (n = 269) were collected during enrollment. The DNA extraction was performed on the automated NucliSENS® easyMAG® system (bioMérieux). The samples were analyzed with two separate in-house PCR assays capable of detecting the most prevalent cutaneous HPV types (i.e. wart-associated HPV qPCR) as well as the most relevant mucosal types (i.e. RIATOL qPCR assay). In total, the type-specific prevalence of 30 distinct HPV genotypes was determined. The beta-globin gene was used as a cellularity control and for viral load quantification. Data concerning wart persistence, previous treatment, wart type, and other relevant wart and patient characteristics was collected through a baseline questionnaire. The study population consisted mostly of persistent warts considering that 98% (n = 263) of the sampled skin lesions were older than six months and 92% (n = 247) had undergone previous treatment. The most prominent wart type was the mosaic verruca plantaris (42%, n = 113). The most prevalent HPV types were cutaneous HPV types 27 (73%, n = 195), 57 (63%, n = 169), and 2 (42%, n = 113). Only 2% (n = 6) of the lesions was HPV negative. The highest median viral loads were observed with HPV27 and 57 (i.e. 6.29E+04 and 7.47E+01 viral copies per cell respectively). The multivariate analysis found significant associations between wart persistence and certain wart types, the number of warts, and HPV genotypes. Based on these findings, persistent warts are more likely to: (1) be verruca vulgaris, verruca plantaris simple or mosaic, (2) to manifest as multiple warts, (3) and to be negative for HPV type 2 or 4. These characteristics can be useful in the clinical setting for future risk stratification when considering treatment triage and management.
Cutaneous warts are benign lesions of the skin, commonly found and widespread among the population, affecting both children (30%) and adults (0.84%-12.9%), with a typically long duration of disease (approx. two years)A systematic review by the Cochrane Skin Group assessed the effects of different treatments for cutaneous warts. It concluded that the rate of clearance remains highly uncertain even after treatment, hereby influencing practitioners to limit treatment efforts and instead opt for a more expectant approachCutaneous warts are caused by infection of the skin with human papillomavirus (HPV), mostly known as the cancer-causing virus, capable of inducing cervical cancerThis article aims to present baseline findings of the study population included in the OVW-SA trial conducted in Flanders, Belgium, comprising complex inter-relationships between patient-specific features as well as wart-specific characteristics, including the most extensive HPV genotyping performed on wart swab samples to date. Based on these findings a detailed epidemiological profile of a typical persistent wart is devised.