RT Journal Article
SR Electronic
T1 Natural Course of Cutaneous Warts Among Primary Schoolchildren: A Prospective Cohort Study
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 437
OP 441
DO 10.1370/afm.1508
VO 11
IS 5
A1 Sjoerd C. Bruggink
A1 Just A. H. Eekhof
A1 Paulette F. Egberts
A1 Sophie C. E. van Blijswijk
A1 Willem J. J. Assendelft
A1 Jacobijn Gussekloo
YR 2013
UL http://www.annfammed.org/content/11/5/437.abstract
AB PURPOSE Because cutaneous warts resolve spontaneously and available treatments often fail, family physicians and patients may consider a wait-and-see policy. We examined the natural course of cutaneous warts and treatment decisions in a prospective observational cohort of primary schoolchildren. METHODS We inspected the hands and feet of children aged 4 to 12 years from 3 Dutch primary schools for the presence of warts at baseline and after a mean follow-up of 15 months. Parental questionnaires at follow-up provided information on inconvenience caused by warts and any treatments used. RESULTS Of the 1,134 eligible children, 1,099 (97%) participated, of whom 366 (33%) had cutaneous warts at baseline. Among these children with warts, loss to follow-up was 9% and the response rate to the parental questionnaires was 83%. The complete resolution rate was 52 per 100 person-years at risk (95% CI, 44–60). Younger age (hazard ratio = 1.1 per year decrease; 95% CI, 1.0–1.2) and non-Caucasian skin type (hazard ratio = 2.0; 95% CI, 1.3–2.9) increased the likelihood of resolution. During follow-up, 38% of children with warts at baseline treated their warts: 18% used over-the-counter treatment only, 15% used a family physician–provided treatment only, and 5% used both. Children were more likely to initiate treatment if the warts measured at least 1 cm in diameter (odds ratio = 3.2; 95% CI, 1.9–5.3) and especially if parents reported that the warts caused inconvenience (odds ratio = 38; 95% CI, 16–90). CONCLUSIONS One-half of primary schoolchildren with warts will be free of warts within 1 year. Young age and non-Caucasian skin type enhance resolution. Children with large or inconvenient warts are more likely to start treatment. These findings will be useful in the process of shared decision making with parents and children.