Characteristics of non-genital warts in the dermato-venereology department of Mangusada Badung General Hospital during in 2019

Characteristics of non-genital warts in the dermato-venereology department of Mangusada Badung General Hospital


INTRODUCTION
Non-genital warts are epidermal hyperplasia caused by infection with the Human Papilloma Virus (HPV). 1 Non-genital warts are subdivided on anatomical or morphological grounds into the common wart, plantar wart, and flat wart, caused by many different types of HPV. 2-4 HPV infection occur worldwide, can affect all age and races, can last months or years, and the incidence rate between male and female is the same. Non-genital warts are most common in children and young adults, where 30% -70% of school-age children have nongenital warts. 5, 6 There are few reliable data on the incidence and prevalence of nongenital warts. Prevalence can vary widely between different age groups, populations, and periods. Two large populationbased studies found the prevalence rate of non-genital warts in the United States was 0.84% and in Russia was 12.9%. The highest prevalence was in children and young adults. Two studies in the school population showed a prevalence rate of 12% in children age 4 to 6 in the UK and 24% at 16 to 18 age in Australia. 7 Treatment of non-genital warts aims to relieve both physical and psychological discomfort in the patient and prevent the spread of infection. Recurrence is common in all treatment modalities and is more common in immunocompromised patients with non-genital warts. Some of the treatment options include topical and surgical procedures aimed at destroying or removing the lesion. 1,2,8 Data on the prevalence or incidence of non-genital warts in Bali is still very limited. Therefore, it is important to identify the incidence, prevalence and characteristics as a

ORIGINAL ARTICLE
reference for conducting further studies on non-genital warts cases.

METHODS
This research is a descriptive crosssectional retrospective study using secondary data from the patient register book and medical records in dermatovenereology outpatient clinic Mangusada Badung general hospital. This research was carried out from February to May 2020. This study's sample was all new cases of non-genital warts at dermatovenereology outpatient clinic Mangusada Badung General Hospital from 1 January -31 December 2019 that meet the inclusion and exclusion criteria. This study's inclusion criteria were new cases of nongenital warts, and the exclusion criteria were re-visit non-genital warts patients cases of genital warts. The variables included in this study were non-genital warts, common warts, flat warts, plantar warts, age and sex. Data were analyzed with SPSS 18 for windows. We presented the categorical data with numbers and percentages and provided cross-tabulation for age and sex variables.

RESULTS
In a period of 1 year, from January 1 -December 31, 2019, the number of patients in dermato-venereology outpatient clinic Mangusada Badung general hospital was 3086. The incidence of non-genital warts was 88 cases (2.85%) ( Table 1). Based on sex, non-genital warts were more frequent in the male population (50 cases) compare to the female population (38 cases) (56.8% vs. 43.2%). Non-genital warts frequency was highest among age 11-20 years, with 31 cases (35.2%). The mean age of nongenital warts patients was 26.18 years. The youngest age is four, and the oldest was 70. Common wart was the most frequent findings, with 82 cases (93.2%), flat wart with 6 cases (6.8%), and no plantar wart case found. The common wart of all the patients in the dermato-venereology outpatient clinic Mangusada Badung General Hospital was 2.66%, and the flat wart was 0.2%. Common warts were more frequent in the male population (47 cases) compared to the female population (35 cases) (57.3% vs. 42.7%). Common wart frequency was highest among ages 11-20, with 30 cases (36.6%). The mean age of common warts patients was 26.2 years. The youngest age was four, and the oldest was 70. The flat wart incidence was equal between males (3 cases) and females (3 cases). Flat wart frequency was highest in both age groups, 11-20 and 41-50, with 2 cases (33.3%). The mean age of flat warts patients was 26 years. The youngest age was eight, and the oldest was 43. The most frequent non-genital warts cases in the male population occured at age 11-20 (20 cases), while in female populations, 11-20 and 21-30 shared the same incidence of non-genital warts (11 cases).

DISCUSSION
The incidence of non-genital warts was 2.85%. This result was higher than the case in the United States, where the prevalence of non-genital warts was 0.84%, but lower when compared study in Russia where the prevalence of non-genital warts was 12.9%. There is little data on the incidence and prevalence of non-genital warts, especially in Indonesia. 7 Common wart was the most frequent findings, with 82 cases (93.2%), flat wart with 6 cases (6.8%), and no plantar wart case found. This result is similar to a study conducted by Ghadgepatil et al. in a district in India where out of 90 cases of non-genital warts that found, the most were common wart (42%), then palmoplantar warts (20%) and flat wart (18%). 3 The incidence of common wart of all the patients in dermato-venereology outpatient clinic Mangusada Badung general hospital was 2.66%. This result is higher than a study conducted by Tampi et al. at dermato-venereology outpatient clinic Prof. Dr. R. D. Kandou hospital in 2013, where common wart incidence was 1.05%. 9 Non-genital warts frequency was highest among age 11-20, with 31 cases (35.2%). This result showed similarity from a study conducted by Liu et al., where the highest number of cases was found in the age group 14-20, with 119 cases (55%). These results support the theoretical basis that non-genital warts can affect any age and occur mostly in children and young adults. 1,7,10 Common wart frequency was highest among age 11-20, with 30 cases (36.6%) in this study. A study conducted by Jonathan et al. also showed that the highest common wart frequency age group was children to young adults, age 5-14 (25.9%) and age 15-24 (37%). 11 Flat wart frequency was highest in age groups 11-20 and 41-50, with 2 cases (33.3%). This result is different from a study conducted by Ghadgepatil et al., where flat wart incidence occurs most often in the age group 1-10. 3 These results could be due to the lack of flat wart cases in dermato-venereology outpatient clinic Mangusada Badung General Hospital. Patients with flat warts rarely come for treatment because complaints tend to be mild, minor cosmetic complaints and often considered non-diseases. 3 Based on sex, non-genital warts are more frequent in the male population than the female population (56.8% vs. 43.2%). This result is similar to a study conducted by Ghadgepatil et al., where the incidence rate in males (66%) was higher than in females (34%). 3 Liu et al. was also found that the incidence rate in males (61.4) was higher than in females (38.6). These may occur because men tend to have more outdoor activities that make them more vulnerable to HPV contact. However, this study's result is still relevant to the theoretical basis that the incidence is equal in males and females slightly different. 3, 10 Common warts are more frequent in the male population than female populations (57.3% vs. 42.7%). This result is similar to a study conducted by Dalimunthe et al., where the incidence rate in males (58.8%) was higher than that of females (42.2%). 12 Incidence of flat wart in this study is equal between male and female. This result is different from a study conducted by Ghadgepatil et al., where the incidence rate in males (55.6%) was higher than that of females (44.4%). 3 These could be due to the lack of flat wart cases found in dermato-venereology outpatient clinic Mangusada Badung general hospital. Patients with flat warts rarely come for treatment because complaints tend to be mild, minor cosmetic complaints and often considered non-diseases.
The most frequent non-genital warts cases in the male population occur at age 11-20 (20 cases), while in the female population, age groups 11-20 and 21-30 share the same incidence of non-genital warts (11 cases) ( Table 2). This result supports the theoretical basis that nongenital warts can affect any age and occur mostly in children and young adults. 1,7

CONCLUSION
Non-genital warts most likely to affect a male population compared to the female population. It tends to occur more frequently in children and young adults. The common wart is the most frequent findings in non-genital warts.

Author contribution
The first author contributed to the implementation of research, data collection, data processing, and script drafting. The second author contributed to drafting and supervising this study.

Ethical statement
Mangusada Badung General Hospital Ethics Commission approved this study with ethical clearance number 119/Kom-Dik/X/2020.