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. 2013;12(12):1411-1415.


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 patient preference.
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.