Natural Course of Cutaneous Warts Among Primary Schoolchildren: A Prospective Cohort Study

Sjoerd C. Bruggink; Just A. H. Eekhof; Paulette F. Egberts; Sophie C. E. van Blijswijk; Willem J. J. Assendelft; Jacobijn Gussekloo

doi:10.1370/afm.1508

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Watchful waiting is best for warts in schoolchildren
Elie Mulhem

Published on: 19 September 2013

Published on: (19 September 2013)
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Watchful waiting is best for warts in schoolchildren
Elie Mulhem, Vice chair, Department of Family Medicine
This article by Bruggink et al examined the natural course of cutaneous warts in a cohort of Dutch school children. Most interestingly they found that 90% of baseline warts have resolved after one year of observation, while the resolution rate was 52% when newly developed warts were included. This study supports the recommendation of watchful waiting as the best initial plan for children presenting with hand and foot wa...
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This article by Bruggink et al examined the natural course of cutaneous warts in a cohort of Dutch school children. Most interestingly they found that 90% of baseline warts have resolved after one year of observation, while the resolution rate was 52% when newly developed warts were included. This study supports the recommendation of watchful waiting as the best initial plan for children presenting with hand and foot warts. The following facts add strength to this recommendation:
1. available wart treatments have modest efficacy [1]
2. cryotherapy (the most commonly used wart treatment by primary care providers) is painful and not well tolerated in younger children. And this study showed that younger children (4-7 years) have the highest rate of resolution
3. overall, trials on cryotherapy failed to show that it is more effective than placebo, except maybe when used on hand warts [2]
When evaluating patients presenting with large or multiple warts, in my experience physicians tend to assume that these warts have a lower chance of spontaneous resolution and for that reason physicians will be more aggressive in initiating treatment. This article showed that these assumptions are not true, since it demonstrated that the size or number of warts did not affect the resolution rate
I believe that family physicians should feel more comfortable discussing watchful waiting as the best initial plan for management of cutaneous warts in children, especially since spontaneous resolution rate is probably higher than resolution rate from available wart treatments.
1. Mulhem, E. and S. Pinelis, Treatment of nongenital cutaneous warts. Am Fam Physician, 2011. 84(3): p. 288-93.
2. Kwok, C.S., et al., Topical treatments for cutaneous warts. Cochrane Database Syst Rev, 2012. 9: p. CD001781.
Competing interests: ?? None declared
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Competing Interests: None declared.