The management of cutaneous warts : a public health approach

In this study it was found that warts accounted for 21% of new referrals to dermatologists at Falkirk and District Royal Infirmary, and took up 19% of clinic time, even though general practitioners in the area made the correct diagnosis in 88% of 142 referrals in which they diagnosed warts. A questionnaire survey of 130 patients treated with cryotherapy for hand warts showed that cryotherapy was the preferred treatment of 76%, and 59% would prefer the treatment in their local health centre. However, only 34% had used wart paints adequately beforehand. Only 57% were free of hand warts 19 months after cryotherapy. A survey of 159 local general practitioners showed 70.4% referred warts because they did not have liquid nitrogen available. A pilot study of cryotherapy in 4 large health centres indicated that far fewer warts would be referred if general practitioners had liquid nitrogen, although the effectiveness of treatment was unclear. Further work is needed to demonstrate the cryotherapy is cost-effective before its wholesale use in general practice can be advocated. Treatment is justified for symptomatic or cosmetic reasons. Cryotherapy is the treatment of choice for most common facial warts and salicylic acid/lactic acid paints are recommended for treatment of warts on the hands and feet. Putative risk factors for hand warts were studied in a cross-sectional survey of men in four occupational groups. Each subject completed a questionnaire, his hands were examined, and scrapings were taken from warts for viral typing by a polymerase chain reaction method. The prevalence of hand warts was higher in 240 abattoir workers (33.3%) and 246 retail and wholesale butchers (34.1%) than in 308 engineers (19.5%) and 292 office workers (14.7%) and the excess was due to human papillomavirus type-7 (HPV-7), which was found in only 2 non-meat workers.