Duct Tape for Treatment of the Common Wart

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Focht DR, et al. "The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart)". Archives of Pediatric and Adolescent Medicine. 2002. 156:971-974.
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Clinical Question

Among children with common warts, does occlusive duct tape therapy result in improved wart resolution when compared to cryotherapy?

Bottom Line

Among children with common warts, this unblinded study that used incomplete statistical analyses suggested that duct tape occlusive therapy more readily and more rapidly leads to wart resolution compared to cryotherapy.

Major Points

The common wart occurs in up to 10% of children, and most are treated with topical agents or cryotherapy. Occlusive therapy with duct tape has been used for years by parents for the treatment of their children's warts, with anecdotal success published as early as 1978.[1] Duct tape therapy is inexpensive, causes little pain, reduces the need of frequent follow-up, and provides parents with a mechanism of treating their children at home. Nevertheless, many clinicians have regarded its effectiveness as an old wives' tale, as no randomized trial had demonstrated its efficacy.

In their 2002 paper, Focht and colleagues describe an open-label randomization of children with common warts to occlusive therapy with duct tape or to liquid nitrogen-based cryotherapy. Duct tape was used for up to two months, whereas liquid nitrogen cryotherapy was applied every 2-3 weeks for up to six treatments. Duct tape was associated with a higher rate of wart resolution than cryotherapy (85% vs. 60%). Most children had resolution within 28 days of duct tape therapy (77%) or after two cryotherapy treatments (60%). Both therapies were well tolerated. In the occlusive therapy group, duct tape applied to one wart led to resolution of distant warts as well, suggesting a systemic immune response.[2]

The trial was limited for many reasons including its unblinded design, small sample size, poor follow-up, and lack of descriptive statistics such as confidence intervals. In addition, the trial's design may be biased against cryotherapy in that it was applied and follow-up was provided by nurses rather than physicians, and liquid nitrogen was applied for an arbitrary 10 seconds per application.[3] A 2012 Cochrane review found no significant benefit to duct tape therapy over placebo when the Focht data were combined with similar studies.[4] Another independent review deemed the evidence for duct tape therapy as low-quality.[5]

Guidelines

There have been no recent guidelines published from major professional organizations regarding this topic.

Design

  • Single center, randomized, open-label trial
  • N=51
    • Duct tape (n=26)
    • Cryotherapy (n=25)
  • Setting: One pediatric/adolescent center in Washington state
  • Enrollment: 2000-2001
  • Mean follow-up: Not explicitly stated
  • Analysis: Not explicitly stated
  • Primary outcome: Wart resolution

Population

Inclusion Criteria

  • Age 3-22 years old
  • Outpatients with common warts

Exclusion Criteria

  • Immunodeficiency states
  • Chronic skin diseases (eg, eczema or psoriasis)
  • Tape allergy
  • Facial, periungual, perianal, or genital warts

Baseline Characteristics

From the duct tape group.

  • Female 50%
  • Age 9.1 years
  • Wart size: 5 mm
  • Wart location:
    • Finger 46%
    • Back of heel 11%
    • Plantar 31%
    • Palmar 8%

Interventions

  • Randomization to either duct tape or cryotherapy:
    • Duct tape: Applied for 6 days (with reapplication if it fell off) followed by removal, soaking in water, and debridement with an emery board or pumice stone followed by reapplication of the duct tape the following day. This continued for up to two months or until resolution of the wart.
    • Cryotherapy: Liquid nitrogen applied for 10 seconds every 2-3 weeks for a maximum of 6 treatments as well as home debridement with and emery board or pumice stone the day before a return visit.

Outcomes

Comparisons are duct tape vs. cryotherapy.

Primary Outcome

Wart resolution
85% vs. 60% (P=0.05; NNT 4)

Secondary Outcomes

Of those attaining wart resolution with duct tape therapy, percentage that were within first 28 days
77%
Of those attaining wart resolution with cryotherapy, percentage that were after two treatments
60%

Adverse Events

Major complications
None in either group.
Minor complications
No quantitative results given though the authors report that duct tape was associated with minor skin irritation. Cryotherapy was associated with pain and burning at the site (an expected complication of the therapy) and anticipatory vomiting in one participant.

Criticisms

  • Small sample size
  • Analysis limited, no confidence intervals provided
  • Inconsistent evaluations of patients; some in person, many by telephone
  • No follow-up so recurrence is unknown
  • Time between therapies may have been longer than optimal treatment
  • Inconsistent clinic follow-up to confirm wart resolution
  • Relatively few participants[5]
  • Unclear how many telephone assessments occurred during the follow-up period and the delay until the assessments were completed[5]

Funding

Not explicitly stated by the authors.

Further Reading

  1. Litt JZ. "Don't excise--exorcise. Treatment for subungal and periungual warts." Cutis. 1978;22(6):673-678.
  2. Buchanan J, Nieland-Fisher NS. "Duct tape vs. cryotherapy in the treatment of Verruca Vulgaris." Arch Pediatr Adolesc Med. 2003;157(5):490.
  3. Abramovits W. "Cryotherapy vs duct tape." Arch Pediatr Adolesc Med. 2003;157(5):491.
  4. Kwok CS, et al. "Topical treatments for cutaneous warts." Cochrane Database Systemic Review. 2012: E-published. Accessed 2013-07-28.
  5. 5.0 5.1 5.2 Loo SK, Tang WY. "Warts (non-genital)." Clinical Evidence (Online). 2009. E-published. Accessed 2013-07-28.