The Treatment and Demographics of Warts: An Analysis of National Trends
December 2013 | Volume 12 | Issue 12 | Original Article | 1411 | Copyright © December 2013
Virginia J. Reeder MD, Cheryl J. Gustafson MD, Scott A. Davis MA,
Alan B. Fleischer Jr. MD,William W. Huang MD MPH
Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC
BACKGROUND: Verrucae (warts) are a very common dermatologic disease. They can be of cosmetic concern, cause physical discomfort,
and predispose patients to certain malignancies. Management of warts has traditionally been based on anatomic location, clinical appearance,
and patient preference.
PURPOSE: To investigate trends in the treatment of warts, as well as patient demographics associated with the diagnosis of warts.
Methods: The National Ambulatory Medical Care Survey (NAMCS) was queried for data regarding patient visits associated with the
diagnosis of warts from 1990 to 2009.
RESULTS: There was a significant increase in the use of topical imiquimod during the study period, such that it became the most frequently
used medication for warts. No statistically significant trends were detected regarding the frequency of treatment with medication only, procedure
only, or combination treatment. In terms of patient demographics, there was an upward trend in regards to increasing patient age and
the diagnosis of warts. However, there were no significant trends with respect to patient gender or race and the diagnosis of warts.
LIMITATIONS: Warts not otherwise specified (NOS) was the reported diagnosis for more than eighty percent of patient visits for warts.
Trends in the treatment of plantar warts could not be evaluated as the ICD-9 code designating this diagnosis was recently instituted in
2009. Data from NAMCS are cross-sectional in nature.
CONCLUSIONS: The advent of a new therapy and shifts in population patterns have modified the epidemiologic profile and treatment of warts. J Drugs Dermatol.
Verrucae, commonly known as warts, are caused by the
human papillomavirus (HPV). Humans are the primary
reservoir for this virus. Infection with HPV is exceedingly
commonplace, and it is thought that most individuals will
be infected by the HPV virus at some point during their lifetime.1 There are a multitude of HPV subtypes; however, classification
of warts is usually based on location and clinical presentation
rather than by histologic or viral genetic subtyping. For example,
warts occurring on the sole of the foot or pudendal region
are termed plantar and genital warts, respectively. In regards
to clinical appearance, warts with a hyperkeratoic appearance
are referred to as common warts, or verruca vulgaris; whereas,
warts that are smoother and less protuberant are known as flat
warts, or verruca planae. For official diagnostic purposes the International
Classification of Disease, Ninth Revision (ICD-9) recognizes
four classifications: genital warts, plantar warts, other
specified warts, and warts not otherwise specified (NOS). Genital
warts and plantar warts are diagnosed based upon anatomic
location. Other specified warts include common warts and flat
warts. Warts NOS is a non-specific category for all other warts
that do not fit into the other categories.
Although warts are common, infection with HPV is not necessarily
a benign process. Warts can cause physical discomfort and
be cosmetically concerning. Moreover, they can become friable
and ooze, which can lead to concern for spread of blood-borne
infection.2 Prolonged HPV infection predisposes to certain malignancies,
such as penile, anal, or cervical cancer.3 Inhalation
of HPV particles can result in laryngeal papillomatosis, a very
serious and potentially life-threatening disease.4
For all of these reasons, patients often receive treatment for
warts and there are a variety of medications and procedures
available for this purpose. Medications treat warts by either
directly destroying the lesion or inducing a local immune response,
which subsequently results in clearing of the lesion.5 Examples of such medications include imiquimod, salicylic
acid, cantharidin, and podophyllin. In regards to procedural
treatments, removal or physical destruction of the lesion is
the primary objective. Procedural options include cryosurgery,
surgical excision, electrodessication and curettage, and
laser therapy. Ultimately, the management of warts has traditionally
been based on location, clinical appearance, and
The main objective of this study was to evaluate trends in the
treatment of warts, as well as patient demographics associated
with the diagnosis of warts.