title: Natural course of cutaneous warts among primary schoolchildren: a prospective cohort study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Sjoerd C
authors.initials: SC
authors.lastname: Bruggink
authors.forename: Just A H
authors.initials: JA
authors.lastname: Eekhof
authors.forename: Paulette F
authors.initials: PF
authors.lastname: Egberts
authors.forename: Sophie C E
authors.initials: SC
authors.lastname: van Blijswijk
authors.forename: Willem J J
authors.initials: WJ
authors.lastname: Assendelft
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017679:Cryotherapy; D003657:Decision Making; D004954:Esthetics; D005194:Family Practice / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000628:therapy; D006229:Hand Dermatoses / Q000628:therapy; D006801:Humans; D008297:Male; D004366:Nonprescription Drugs / Q000627:therapeutic use; D010146:Pain / Q000209:etiology; D010358:Patient Participation; D011446:Prospective Studies; D012075:Remission, Spontaneous; D020156:Salicylic Acid / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D014860:Warts / Q000150:complications / Q000473:pathology / Q000628:therapy*; D057832:Watchful Waiting
chemical_list: D000890:Anti-Infective Agents; D004366:Nonprescription Drugs; D020156:Salicylic Acid
keywords: cutaneous warts; natural course; primary care; schoolchildren
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