Background: Refractory warts remain unresponsive to a variety of treatment modalities. A questionnaire survey that includes information regarding patients’ symptoms and history can provide a deeper understanding of the discomfort and difficulties experienced by patients. Objective: We used a questionnaire to investigate the clinical characteristics, treatment methods, and discomfort experienced by patients diagnosed with recalcitrant warts. Methods: This survey was performed in patients with warts who first visited the Dermatology Department at Severance Hospital between March 1, 2018 and March 31, 2020. The questionnaire included information regarding age, sex, family history, disease onset, location and number of lesions, treatment history, and effectiveness. Results: Among the 116 patients with recalcitrant warts included in this study, the mean number of lesions was 6.73; most lesions were observed on the hands and feet. The most common treatment performed previously included cryotherapy (89/116, 76.7%), followed by topical application of medications (69/116, 59.5%), and laser therapy (47/116, 40.5%). Of the total respondents, 60.3% (70/116) of patients admitted that previous treatment was ineffective, and 83.6% (97/116) of patients had one or more complaints secondary to the warts. Conclusion Treatment of recalcitrant warts should focus on selection of an optimal therapeutic option based on patients’ treatment history, discomfort, and effects on their quality of life. This study would serve as a guideline to establish a future classification and treatment algorithm for recalcitrant warts.

Background: Purse-string suture is a simple technique to reduce wound size and to achieve complete or partial closure of skin defects. Objective: To classify situations in which purse-string sutures can be utilized and to assess the long-term size reduction and cosmetic outcome of the final scar. Methods: Patients (93 from Severance hospital and 12 from Gangnam Severance hospital) in whom purse-string sutures were used between January 2015 and December 2019 were retrospectively reviewed. Wound site, final reconstruction method, repair duration, final wound size, and Vancouver scar scale were assessed. Results: A total of 105 patients were reviewed. Lesions were located on the trunk (48 [45.7%]), limbs (32 [30.5%]), and face (25 [23.8%]). Mean ratio of wound length/primary defect length was 0.79±0.30. Multilayered purse-string suture showed the shortest duration from excision to final repair (p<0.001) and most effectively minimized the scar size (scar to defect size ratio 0.67±0.23, p=0.002). The average Vancouver scar scale measured at the latest followup visit at least 6 months postoperatively was 1.62, and the risk of hypertrophic scarring was 8.6%. There was no significant difference in the Vancouver scar scale and the risk of hypertrophic scarring between the different surgical method groups. Conclusion Purse-string sutures can be utilized in many stages of reconstruction to effectively reduce scar size without compromising the final cosmetic outcome.