Hogendoorn et al evaluated factors which might be predictive of response of a cutaneous wart to therapy. The authors are from Leiden University, DDL Diagnostic Laboratory and Roosevelt Clinics in Leiden, the Netherlands.
Therapy may include:
(1) monochloroacetic acid (MCA)
(2) cryotherapy plus salicylic acid
(3) cryotherapy alone
Features of an individual wart to observe:
(1) presence of black dots (capillary thrombosis), a finding associated with a positive HPV typing test
(2) callus
(3) location relative to skin surface
(4) border sharply defined or not
(5) border erythema
(6) HPV type
Therapy with MCA or cryotherapy plus salicylic acid:
(1) tends to work well on a wart showing black dots (capillary thrombosis)
(2) tends to work less well with warts caused by HPV2, HPV27 and HPV57 (members of the alpha genus)
Warts showing HPV1 tend to have a favorable response to cryotherapy plus salicylic acid.
Cryotherapy by itself is less effective when:
(1) there is a callus
(2) there is border erythema
(3) the wart is nonelevated (location deep in the skin, as in plantar warts) rather than elevated
