Dermoscopy Can Accurately Predict Treatment Success of Cryotherapy

Image Credit: © Evgeniy Kalinovskiy - stock.adobe.com

A new study observed that dermoscopy can be used to predict the outcome of cryotherapy for cutaneous warts, thus providing a better understanding of which characteristics of warts best respond to this type of treatment.¹ Dermoscopy is frequently used to diagnose warts, especially papillary capillaries, but is not currently used as a predictive tool.²

“Although cryotherapy is one of the most frequently used treatments, practical tools that can directly predict the treatment outcomes in clinical settings are lacking,” the authors wrote. “This highlights the need for predictive tools that can identify warts likely to respond positively to cryotherapy, thereby optimizing patient outcomes and minimizing discomfort by considering alternative treatment options early.”

The retrospective analysis was conducted at Pusan National University Hospital in Korea and took place from January 2001 to October 2023. Included participants (n = 103) were aged 4 years and older and had common or plantar warts. Patients completed 3 sessions of cryotherapy across a 4-month period. The treatment regimen included paring, if necessary, and 2 or 3 rounds of 10 to 20-second freeze-thaw cycles using a cryo-gun with liquid nitrogen.

Altogether, 119 warts were analyzed. Researchers evaluated several features of each wart, including vascularity, papillary and surface scale patterns, background color, skin markings, and margin characteristics. Clinical and dermoscopic images were taken throughout the study. Treatment responses were categorized as complete (clearance of warts), partial (50–99% reduction in size), or none (< 50% reduction in size). Those that reached complete response had marked surface scales and well-defined margins.

In total, 37 (31.1%) warts had no response to treatment, 31 (26.1%) showed a partial response, and 51 (42.9%) exhibited a complete response. Warts with marked surface scales, well-defined margins, and dots were more likely to respond favorably to treatment, while the amount of hemorrhage, crust, and skin crease breakage did not affect response.

In the group with a complete response, marked surface scales were observed 6.59 times more frequently, well-defined margins were 4.1 times more common, and dots were 4.07 times more common compared to the group with no response. Minimal surface scales were also less common in this group (p = .001).

Further analysis revealed that the group exhibiting a partial response demonstrated a 2.51-fold higher frequency of marked surface scales than that in the no-response group. Similar results were found in the complete response group compared to the no-response group. Dots were 4.07 times more prevalent (p = 0.017, 95% CI 1.28–12.9), marked surface scales were 6.59 times more prevalent (p = 0.001, 95% CI 2.36–18.34), and well-defined margins were 4.10 times more prevalent (p = 0.012, 95% CI 1.36–12.37).

Significant differences in findings were also observed between common warts and plantar warts. In common warts, vascularity was 11.65 times more frequent (p = 0.013 [95% CI, 1.68, 80.85]), dots were 8.85 times (p = 0.032 [95% CI, 1.27, 66.67]), and marked surface scales were 12.05 times (p = 0.008 [95% CI, 1.94, 74.78]). Conversely, a background color of red or pink was 14.00 times more likely to be observed in plantar warts (p = 0.027 [95% CI, 1.37, 145.65]).

According to investigators, there were some limitations, such as the retrospective study design and the small number of patients in each plantar and common wart subgroup. Despite this, the research highlights the potential of a more personalized approach to managing warts as dermoscopy could be used as both a diagnostic tool and a predictor of treatment outcomes.

References

1. Cha S, Lee GW, Shin JO, et al. Predictive dermoscopic features of cryotherapy treatment response in cutaneous warts. Sci Rep. 2024;14(1):29363. Published 2024 Nov 26. doi:10.1038/s41598-024-80608-7

2. Al Rudaisat M, Cheng H. Dermoscopy Features of Cutaneous Warts. Int J Gen Med. 2021;14:9903-9912. Published 2021 Dec 16. doi:10.2147/IJGM.S335276