Clinical Characteristics of Plantar Warts and Association With BMI: A Retrospective Case Series Study

Plantar warts are among the most common skin lesions caused by the human papillomavirus (HPV) and are highly resistant to treatment. Obesity is a well-established factor for skin disease, yet few studies have focused on its association with plantar warts. This study aimed to describe the clinical characteristics of plantar warts and their relationship with body mass index (BMI).

This retrospective case series included patients with plantar warts treated at the dermatology department of the Third People's Hospital of Hangzhou between May 2023 and March 2025. An electronic medical record system was used to collect participants' demographic and clinical data. Dermoscopy was used to evaluate wart dermatological features, focusing on two key aspects: vascularity and surface patterns. Patients were categorized into two groups based on BMI: BMI ≥ 24.0 kg/m² and BMI < 24.0 kg/m², to compare their dermatological characteristics.

A total of 262 patients with plantar warts were included in the study (average age: 37 ± 12.75 years), with more females (55.73%) than males (44.27%). Most plantar warts were single lesions (66%) and appeared predominantly on the soles (49%) and toes (29%). Dermoscopically, the majority exhibited dotted blood vessels (79%) and a yellow or brown color, both for the background (74%) and surface pattern (68%). Among the 262 patients, 90 were in the BMI ≥ 24.0 kg/m² group (34.25%), and 172 were in the BMI < 24.0 kg/m² group (65.65%). Compared to the BMI< 24 kg/m² group, the BMI≥24 kg/m² group had a significantly higher proportion of males (61.11% vs. 35.47%, p < 0.001), frogspawn (35.56% vs. 19.77%, p = 0.012), and papilliform patterns (7.78% vs. 5.81%). No statistically significant differences were observed in age, number of warts, location, background color, and vascular characteristics between the two groups (p > 0.05).

This case series demonstrate the utility of dermoscopy as a non-invasive and cost-effective tool for identifying and characterizing the features of plantar warts. Our descriptive findings revealed variations in the dermoscopic patterns of plantar warts across different BMI categories. Our findings offer preliminary insights into the clinical presentation of plantar warts, paving the way for future studies with more robust design and statistical analysis.