CWARTS: a novel system for cutaneous wart assessment

  • Br J Dermatol

  • Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • The Cutaneous WARTS (CWARTS) diagnostic tool for assessment and classification of cutaneous warts is presented.

Why this matters

  • Cutaneous warts have a highly variable clinical appearance and do not have a standardized assessment tool.

Key results

  • Included characteristics: solitary vs confluent arrangement, elevated vs skin level, rough vs smooth aspect, border definition, white skin flakes, black dots (capillary thrombosis), red vs lighter color, border erythema, and callus.
  • Black dots, arrangement, border erythema, and border sharpness had the greatest intraclass correlation coefficients (ICCs) for interobserver agreement in the first validation phase (0.85, 0.65, 0.64, and 0.60, respectively).
  • Black dots, border erythema, arrangement, and color had the greatest ICCs for interobserver agreement in the second validation phase (0.68, 0.64, 0.58, and 0.55, respectively).
  • Black dots, border erythema, and color had the greatest ICCs for intraobserver agreement in the second validation phase (0.70, 0.69, and 0.59, respectively).

Study design

  • The CWARTS tool was developed based on literature and semistructured interviews, tested by 28 physicians who assessed 10 different warts and validated by the masked and independent scoring of 299 photographs by 6 observers for interobserver agreement and 4 observers for intraobserver agreement.
  • Funding: None disclosed.

Limitations

  • Small sample for first validation phase.