To the Editor: Warts caused by the human papillomavirus are common. The prevalence of cutaneous warts in children varies (3.3% to 33%).1 As warts are contagious and cosmetically discomforting, patients often seek information regarding warts on the internet. YouTube has become a popular source of medical information.2, 3, 4 In this study, we aimed to analyze the characteristics, quality, and credibility of YouTube videos on warts.
We searched YouTube on March 19, 2021, using the key terms “warts” and “wart”. The results were ranked by “hit-based ranking” and the 100 most-viewed videos for each term were extracted. A total of 109 videos were found, excluding overlaps. Videos (English) on warts that were longer than 1 min were selected. The topic, purpose, views, video power index (VPI), and treatments suggested in each video were noted. Videos were evaluated by 2 raters using the quality scoring tools (DISCERN, JAMA [Journal of the American Medical Association] benchmark criteria, GQS [Global Quality Scale]), with highest scores of 80, 4, and 5, respectively.2,3 VPI determined the popularity of the videos (VPI = [like count/(dislike count + like count)] × 100]. “Daily view count” was the number of views divided by the number of days that the video was posted. Statistical significance was defined as a two-tailed P value of <0.05. The study satisfied the definition of institutional review board exempt research.
Finally, 85 videos meeting the inclusion criteria were assessed (Table I). Of these, 79 addressed nongenital warts (92.9%), whereas 5 (5.9%) concerned genital warts. One video (1.2%) included both. Fifty-seven (67.1%) were created by medical professionals, and 28 (32.9%) were created by nonprofessionals. Videos created by medical professionals had higher VPIs (P = .004), were longer (P = .028), appeared for a shorter number of days on YouTube (P = .004), and had higher quality scores (P < .001) than those by nonprofessionals.
Table I.
Video characteristics of YouTube videos on warts and quality scores by video producer
| Category | Total (N = 85) | Professional (n = 57, 67.1%) | Nonprofessional (n = 28, 32.9%) | P value |
|---|---|---|---|---|
| YouTube metric, mean (SD) | ||||
| Median video views | 1,885,294 (3,118,803.9) | 1,531,615.1 (1,557,175) | 2,605,283.3 (4,942,744.3) | .271 |
| Median days on YouTube | 1619.2 (1061.4) | 1352.8 (920.5) | 2161.3 (1137.1) | .001 |
| Median daily view count | 1761.6 (2737) | 1675.9 (2080.5) | 1936.2 (3779) | .736 |
| Median number of likes | 10,245.9 (11,517.1) | 11,115.7 (10,875.8) | 8475.3 (12,747.1) | .323 |
| Median number of dislikes | 823 (1288) | 635.3 (604.3) | 1205.2 (2044) | .159 |
| Median number of comments | 912.1 (1815.1) | 705.8 (1062.6) | 1332.2 (2763.3) | .256 |
| Median video power index (VPI) | 87.2 (15) | 92.1 (6.5) | 77 (21.2) | .001 |
| Median video length (sec) | 422.4 (327.5) | 477.8 (334.5) | 309.6 (286.3) | .025 |
| Types of warts, n (%) | .435 | |||
| Nongenital warts | 79 (92.9%) | 54 (94.7%) | 25 (89.3%) | |
| Genital warts | 5 (5.9%) | 2 (3.5%) | 3 (10.7%) | |
| Both | 1 (1.2%) | 1 (1.8%) | ||
| Video content∗, n (%) | ||||
| Pathogenesis | 40 (47.1%) | 27 (47.4%) | 13 (46.4%) | .935 |
| Symptoms and signs | 81 (95.3%) | 55 (96.5%) | 26 (92.9%) | .595 |
| Treatment | 80 (94.1%) | 55 (96.5%) | 25 (89.3%) | .326 |
| Prognosis | 39 (45.9%) | 28 (49.1%) | 11 (39.3%) | .392 |
| Number of contents, mean (SD) | 2.8 (0.8) | 2.89 | 2.68 | .255 |
| Purpose, n (%) | <.001 | |||
| Education | 73 (85.9%) | 57 (100%) | 16 (57.1%) | |
| Patient experience | 9 (10.6%) | 9 (32.1%) | ||
| Comic video | 3 (3.5%) | 3 (10.7%) | ||
| Treatments, n (%) | .003 | |||
| Evidence-based treatments† | 67 (78.8%) | 51 (89.5%) | 16 (57.1%) | |
| Alternative treatments‡ | 11 (12.9%) | 3 (5.3%) | 8 (28.6%) | |
| Both | 2 (2.4%) | 1 (1.8%) | 1 (3.6%) | |
| None | 5 (5.9%) | 2 (3.5%) | 3 (10.7%) | |
| Quality score, mean (SD) | ||||
| DISCERN | 36.9 (10.3) | 41 (8.3) | 28.5 (8.7) | <.001 |
| JAMA benchmark score | 1.7 (0.5) | 2.0 (0.3) | 1.2 (0.4) | <.001 |
| GQS score | 3.6 (1.0) | 3.9 (0.7) | 2.9 (1.1) | <.001 |
Bold font indicates statistical significance (P < .05).
All analyses were performed using IBM SPSS Statistics 26.0.
GQS, Global Quality Scale; JAMA, Journal of the American Medical Association.
Each video can fall under multiple categories.
Evidence-based treatments included salicylic acid, cryotherapy, immunotherapy, laser, cantharidin, phenol, podophyllin, retinoids, surgery, trichloroacetic acid, duct tape, and silver nitrate.
Complementary treatments included apple cider vinegar, banana peel, castor oil, baking soda, onion, lemon juice, aloe vera, honey, garlic, potatoes, and tea tree oil.
Sixty-seven videos (78.8%) proposed evidence-based treatments, 11 (12.9%) presented complementary medicine, and 2 (2.4%) contained both. The videos by medical professionals included more evidence-based medicine than those by nonprofessionals (P = .003). Specifically, 9 videos (32.1%) by nonprofessionals and 4 videos (7%) by professionals suggested complementary medicine for the treatment of warts. Alternative medicines introduced by professionals included tea tree oil, apple cider vinegar, and banana peel, while those by nonprofessionals involved castor oil, baking soda, onion, lemon juice, aloe vera, honey, garlic, potato, apple cider vinegar, banana peel, and lemon juice. Although alternative treatments can be used when physicians are not available, cautions are required as side effects and efficacy have not been sufficiently verified. Some home remedies, such as garlic, can cause skin burn.5
YouTube videos offer various treatment options, including evidence-based treatment and alternative medicine. Our study found that videos on warts created by medical professionals were longer, had higher VPIs, and achieved higher quality scores than those by nonprofessionals.
Considering the growing public demand for online medical resources, the participation of medical professionals and the continual quality evaluation of YouTube videos are required to ensure that patients have access to accurate and reliable health information.
Conflicts of interest
None disclosed.
Footnotes
Funding sources: None.
IRB approval status: Exempt due to the use of publicly available data.
Key words: HPV – human papilloma virus; public health informatics; treatment; warts; YouTube.
References
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