Risk factors for recurrence after successful treatment of warts: the role of smoking habits

Abstract

Background

Several therapies have been proposed for cutaneous warts without results concerning factors affecting recurrences.

Objective

To determine the importance of individual characteristics and different therapy modalities in the occurrence of relapses.

Methods

Observational prospective cohort study including 199 patients affected by multiple plantar warts treated as follows: 49 with keratolytics, 50 with CO2 laser, 50 with pulsed dye laser (PDL) and 50 with cryotherapy. Personal data were evaluated through a questionnaire and treatment information were collected. A Cox regression analysis was performed in order to identify independent factors for relapse occurrence.

Results

57,8% of patients showed a persistent clearance of warts after treatment with a higher relapse free interval (RFI) when treated with PDL. Accordingly, the risk of recurrence was increased with CO₂ laser (HR 2.92, 95% CI 1.49-5.74) and keratolytic treatment (HR 3.23, 95% CI 1.60-6.54), as compared to PDL. Furthermore, the multivariate analysis highlighted an higher risk of recurrence in patients between 26-35 years (HR 1.88, 95% CI 1.03-3.45), older than 35 (HR 2.23, 95% CI 1.23-4.07) and smokers (HR 4.90, 95% CI 3.09-7.78).

Conclusions

PDL was found to be characterized by the lowest rate of recurrence. Furthermore, our study highlight that the risk of warts relapse is 5-fold higher in smokers compared to non-smokers, revealing the importance of the effects of smoking on inflammation and immune response.

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