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Duct tape removes warts. (Patient Oriented Evidence that Matters).

Focht DR III, Spicer C, Fairchok MP Efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart). Arch Pediatr Adolesc Med 2002; 156:971-4.

* PRACTICE RECOMMENDATIONS

Duct tape (or any durable, occlusive, tacky tape) appears to be at least as effective as traditional cryotherapy for removal of the common wart. It is an unusual and welcome event in health care when a common ailment is proven equally amenable to an inexpensive, tolerable, and safe alternative therapy.

* BACKGROUND

Is the application of duct tape as effective as cryotherapy in the treatment of common warts? The common wart occurs in 5% to 10% of all pediatric patients. Cryotherapy with liquid nitrogen is currently the treatment of choice in many pediatric offices. However, anecdotal reports in the literature have suggested that tape occlusion therapy also may be effective.

* POPULATION STUDIED

A total of 61 patients between the ages of 3 and 22 years were initially enrolled over a period of 9 months. Each was an outpatient of the Madigan Army Medical Center and was scheduled for treatment of common warts or was observed to have them.

Patients were excluded if warts were located on the face or on the periungual, perianal, or genital areas; if previous cryotherapy had been performed on the same wart; or if they were immunodeficient or had a chronic skin disease.

* STUDY DESIGN AND VALIDITY

In this randomized, single-blinded trial, cryotherapy was compared with duct tape for the treatment of common warts. Patients were randomized by using a computer-generated code after nursing personnel measured the initial diameter of the study wart. The report did not indicate whether treatment allocation was withheld from the enrolling researcher.

The cryotherapy group returned to the clinic every 2 to 3 weeks for a maximum of 6 treatments or until wart resolution (maximum treatment period of 15 weeks). The day before evaluation and retreatment, patients were to debride the wart with an emery board.

The duct tape group was required to return to the clinic every 4 weeks for a maximum of 2 months, but only if the wart was still present as determined by the patient.

A piece of duct tape the size of the wart was applied for 6 days. After 6 days, the tape was removed, and the wart was soaked in water and then debrided. Tape was left off overnight and then new tape was applied for another 6 days.

Before a clinic visit, the tape was removed to keep nursing personnel blinded. However, once a wart was evaluated, nurses became unblinded to determine which group the patient was in for further therapy. Further visits could conceivably consist of an evaluation by the unblinded nurse. It is also appears that patients in the tape group who reported wart resolution within the first 4 weeks never had wart resolution visibly confirmed by nursing personnel.

* OUTCOMES MEASURED

The primary outcome measured was complete resolution of the study wart. A secondary outcome measure was time to resolution.

* RESULTS

Of 61 patients initially enrolled in the study, 51 were included in the final analysis (26 in the duct tape group and 25 in the cryotherapy group). Nine patients were not available for follow-up (3 in the duct tape group and 6 in the cryotherapy group), and 1 patient from the tape group suffered a traumatic amputation of the toe with the study wart.

More patients receiving duct tape therapy experienced complete resolution of their warts than those receiving standard cryotherapy (85% vs 60%; number need to treat=4; 95% confidence interval, 2-91). Of the 22 warts that resolved with duct tape therapy, 73% disappeared within the first 4 weeks. Of the 15 warts that resolved with cryotherapy, 60% resolved during approximately the same period.

Thomas J. Lynch, PharmD, Department of Family and Community Medicine, Eastern Virginia Medical School, Norfolk. E-mail: lyncht@evms.edu.
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Article Details
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Author:Lynch, Thomas J.
Publication:Journal of Family Practice
Geographic Code:1USA
Date:Feb 1, 2003
Words:644
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