Standardized Classification Tools in Dermatology: Time to Focus on Cutaneous Warts

In the February 2018 issue of the British Journal of Dermatology, Hogendoorn et al. introduced the Cutaneous WARTS (CWARTS) diagnostic tool, a new system for characterizing and classifying cutaneous warts based on objective and subjective features. The CWARTS tool evaluates warts based on size, periungual location, and nine subjective features, including arrangement, level, aspect, border, color, and the presence of white skin flakes, black dots, border erythema, and callus. The study found moderate to strong inter- and intra-observer agreement for seven of the subjective features, suggesting the tool's potential for clinical practice. Although currently limited to common, plantar, and periungual warts, future versions could include other wart variants. The tool could also help identify correlations between wart characteristics and HPV subtypes or treatment responses. The authors are conducting further studies and suggest that future work should investigate inter-observer agreement between photographs and clinical assessments, as well as introduce a severity score for each clinical feature to enhance the tool's practicality for treatment monitoring. The CWARTS tool is seen as a promising standardized assessment method for cutaneous warts, with significant potential for use in daily practice and clinical trials.