Duct tape occlusion therapy: Difference between revisions
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→Follow-up studies used different duct tape: rv more good-faith edits; we need to stick to what's reported |
Adding local short description: "Method of treating warts", overriding Wikidata description "method for treating warts by keeping them covered with duct tape for an extended period" |
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{{Short description|Method of treating warts}} |
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'''Duct tape occlusion therapy''' (DTOT) is a method of treating [[wart]]s by covering them with [[duct tape]] for prolonged periods. |
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The manner in which duct tape appears to work is unclear.<ref name="kwok2012">{{cite journal |last1= Kwok |first1=CS |last2= Gibbs |first2= S|last3= Bennett |first3= C| last4= Holland | last5= Abbott |first4= R| year= 2012 |title= Topical treatments for cutaneous warts. |journal= Cochrane Database of Systematic Reviews |volume= 9|issue=9 |pages= CD001781|doi= 10.1002/14651858.CD001781.pub3 | pmid=22972052|pmc= 8101088 }}</ref> The tape might create a [[Skin maceration|macerating]] and [[keratolytic]] environment, stimulating an [[immune response]].<ref name="kwok2012" /> The type of adhesive in the duct tape is likely to be important as leeching of the adhesive into the skin may be causing the immune system response.<ref name =Samlaska /> [[Side effect]]s can include skin irritation and peeling.<ref name="nhs" /> |
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Scientific evidence into the effectiveness of wart treatments, including the use of certain duct tapes, is inconclusive due to the inadequacies of the studies that have taken place. Gibbs et al reviewed 52 trials, concluding, "The evidence provided by these studies was generally weak because of poor methodology and reporting."<ref name="Gibbs2003">{{cite journal |last1= Gibbs |first1=S |last2= Harvey |first2= I|last3= Sterling |first3= JC |last4= Stark |first4= R| year= 2003 |title= Local treatments for cutaneous warts |journal= Cochrane Database of Systematic Reviews|volume= |issue=3 |pages= |publisher=Cochrane Skin Group |doi=10.1002/14651858.CD001781 |url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001781/abstract |accessdate=24 August 2013}}</ref> Professor Hywel C Williams, described the history of [[randomized controlled trials]](RCTs) into viral warts as "largely a shambles".<ref name="williams2003">{{cite journal |last1= Williams |first1=Hywel | year= 2003 |title= Commentary on 'Duct tape occlusion treatment increased resolution in common paediatric warts' |journal= Evidence Based Medicine|volume=8 |issue=2 |pages=58 |publisher=British Medical Journal |doi=10.1136/ebm.8.2.58 |url=http://ebm.bmj.com/content/8/2/58.full#article-title-2 |accessdate=24 August 2013}}</ref> A more recent meta analysis of 85 trials also concluded, "providing a useful idea of 'what works' from such a wide range of studies was difficult as many studies were of poor quality." <ref name="kwok2012">{{cite journal |last1= Kwok |first1=CS |last2= Gibbs |first2= S|last3= Bennett |first3= C| last4= Holland | last5= Abbott |first4= R| year= 2012 |title= Topical treatments for cutaneous warts. |journal= Cochrane Database of Systematic Reviews |volume= 9|issue=9 |pages= CD001781|publisher=Cochrane Skin Group |doi= 10.1002/14651858.CD001781.pub3 |url=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001781.pub3/abstract |accessdate=24 August 2013 | pmid=22972052}}</ref> |
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| ⚫ | There is mixed evidence that occlusive treatment with various types of duct tape is effective.<ref name="kwok2012" /> Clinical trials in 2012 concluded that no [[statistical significance|statistically significant]] difference between clear duct tape and [[placebo]] could be determined within the sample.<ref name="kwok2012" /> On health information websites, duct tape is referred to as a treatment with mixed evidence of efficacy, no good evidence or described as [[alternative medicine]].<ref name="nhs">{{cite web |url=http://www.nhs.uk/Conditions/Warts/Pages/Treatment.aspx |title=Warts and verrucas - Treatment |publisher=nhs choices |access-date=August 24, 2013}}</ref><ref name="patient.co.uk">{{cite web |url = http://patient.info/health/warts-and-verrucas-leaflet|title = Warts and Verrucas|website = patient.info|publisher = www.patient.info|access-date = August 24, 2013}}</ref><ref name="aad">{{cite web |url=http://www.aad.org/dermatology-a-to-z/for-kids/about-skin/warts/how-to-get-rid-of-warts|title=How to get rid of warts |publisher= American Academy of Dertmatology|access-date=August 24, 2013}}</ref><ref name="bupa">{{cite web |url=http://www.bupa.co.uk/individuals/health-information/directory/enwiki/w/warts-and-verrucas|title=Warts and Verrucas |publisher= Bupa|access-date=August 24, 2013}}</ref><ref name="mayo">{{cite web |url=http://www.mayoclinic.org/diseases-conditions/plantar-warts/basics/alternative-medicine/con-20025706|title=Plantar Warts|author=Mayo Clinic Staff |publisher=The Mayo Clinic|access-date=August 24, 2013}}</ref> |
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| ⚫ | Jerome Z Litt |
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Despite the mixed evidence for efficacy, the simplicity of the method and its limited side-effects leads some researchers to be reluctant to dismiss it.<ref>{{Cite journal |last1=Stubbings |first1=Alison |last2=Wacogne |first2=Ian |date=2011-09-01 |title=Question 3 What is the efficacy of duct tape as a treatment for verruca vulgaris? |url=https://adc.bmj.com/content/96/9/897 |journal=Archives of Disease in Childhood |language=en |volume=96 |issue=9 |pages=897–899 |doi=10.1136/archdischild-2011-300533 |issn=0003-9888 |pmid=21836182|s2cid=206853952 }}</ref> |
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== Effectiveness == |
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__TOC__ |
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The strongest evidence of the efficacy of duct tape occlusion therapy in the treatment of warts comes from a study by Rick Focht et al.<ref name="focht02">{{cite journal |author=Focht DR, Spicer C, Fairchok MP |title=The efficacy of duct tapes vs cryotherapy in the treatment of verruca vulgaris (the common wart) |journal=Archives of Pediatrics & Adolescent Medicine |volume=156 |issue=10 |pages=971–4 |date=October 2002 |pmid=12361440 |url=http://archpedi.jamanetwork.com/article.aspx?articleid=203979}}</ref> Focht et al treated 51 children/young adults from aged 3 to 22 with either standard duct tape with rubber based adhesive, or [[cryotherapy]] (liquid nitrogen). They found the duct tape treatment significantly more effective than the cryotherapy (P=0.05) with 85% in the duct tape treatment group having a complete resolution of their wart, compared to 60% in the cryotheraphy group. |
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| ⚫ | In 1978, Jerome Z Litt was the first to suggest that adhesive tape could be used to treat warts on the fingers. He claimed: "My method is safe, easy, simple, painless, inexpensive, and highly effective. It leaves no scarring or deformed nails. The mystery remains: How and why does this method work? I cannot offer any reasonable or logical explanation. It cannot be all 'hypnotic' or 'suggestive.' Could it be that the airtight occlusion and a chemical reaction set up by the adhesive in the tape might combine to release a chemical or '[[toxin]]' causing the formation of [[antibody|antibodies]]? Whatever it may be, it works. I recommend that you try it."<ref>{{cite journal |pmid=720133 |year=1978 |last1=Litt |first1=J. Z |title=Don't excise--exorcise. Treatment for subungual and periungual warts |journal=Cutis |volume=22 |issue=6 |pages=673–6 }}</ref> |
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There are various criticisms of this study. Hywel Williams points out the lack of a [[placebo group|placebo (control) group]] <ref name = "williams2003" /> and Gibbs et al noted that a number of outcome assessments were done over the telephone.<ref name="Gibbs2003" /> There was also no reported longer term follow up to ensure no recurrence of the warts. Further analysis and commentary of the study is available. <ref name="demichele" /><ref name="williams2003" /><ref>{{cite journal |author=Miller KE |title=Duct tape more effective than cryotherapy for warts |journal=American Family Physician |volume=67 |issue=3 |date=February 2003 |url=http://www.aafp.org/afp/2003/0201/p614.html}}</ref> |
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A 2002 study involved 51 individuals (aged 3–22) treated with either "standard duct tape" (not otherwise specified in the study) or cryotherapy. A piece of duct tape was cut as close to the size of the wart as possible, and applied to the area. The tape was left on for 6 days and replaced with new duct tape if it fell off. After 6 days, the tape was removed, the area soaked in water, and the wart [[debridement|debride]]d with an [[emery board]] or [[pumice stone]]. The tape was left off overnight and reapplied on the following morning. This process continued for up to 2 months or until the wart was resolved, whichever occurred first. Progress was monitored every 4 weeks. The researchers found the duct tape treatment significantly more effective than the cryotherapy (P=0.05) with 85% in the duct tape treatment group having a complete resolution of their wart, compared to 60% in the cryotherapy group.<ref name="focht02">{{cite journal |vauthors=Focht DR, Spicer C, Fairchok MP |title=The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart) |journal=Archives of Pediatrics & Adolescent Medicine |volume=156 |issue=10 |pages=971–4 |date=October 2002 |pmid=12361440 |doi=10.1001/archpedi.156.10.971|doi-access=free }}</ref> The study was criticized due to lack of a [[placebo group|placebo control group]],<ref name="williams2003">{{cite journal |last1= Williams |first1=Hywel | year= 2003 |title= Commentary on 'Duct tape occlusion treatment increased resolution in common paediatric warts' |journal= Evidence Based Medicine|volume=8 |issue=2 |pages=58 |doi=10.1136/ebm.8.2.58 |doi-access=free }}</ref> and because a number of outcome assessments were done by phone.<ref name="Gibbs2003">{{cite journal |last1= Gibbs |first1=S |last2= Harvey |first2= I|last3= Sterling |first3= JC |last4= Stark |first4= R|editor1-first=Sam |editor1-last=Gibbs | year= 2003 |title= Local treatments for cutaneous warts |journal= Cochrane Database of Systematic Reviews|issue=3 |pages= CD001781|doi=10.1002/14651858.CD001781 |pmid=12917913}}</ref> There was also no reported long term follow up to ensure no recurrence of the warts.<ref name="williams2003" /><ref name="focht02"/> |
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Notwithstanding these criticisms, this study gives the clearest indication that standard{{clarify|date=April 2014}} duct tape, with rubber based adhesive, has a positive effect on treating warts. |
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Two later studies failed to repeat the results of the 2002 study.<ref name="de haen">{{cite journal |vauthors=de Haen M, Spigt MG, van Uden CJ, van Neer P, Feron FJ, Knottnerus A |title=Efficacy of duct tape vs placebo in the treatment of verruca vulgaris (warts) in primary school children |journal=Archives of Pediatrics & Adolescent Medicine |volume=160 |issue=11 |pages=1121–5 |date=November 2006 |pmid=17088514 |doi=10.1001/archpedi.160.11.1121 |doi-access=free }}</ref><ref name ="wenner">{{cite journal |vauthors=Wenner R, Askari SK, Cham PM, Kedrowski DA, Liu A, Warshaw EM |title=Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial |journal=Archives of Dermatology |volume=143 |issue=3 |pages=309–13 |date=March 2007 |pmid=17372095 |doi=10.1001/archderm.143.3.309 |doi-access= }}</ref> One compared duct tape with [[moleskin]], finding no statistically significant difference in results reported between the two groups.<ref name ="wenner" /> Both studies used 3M clear duct tape, again concluding no statistically significant effect on wart resolution.<ref name="de haen" /> The [[statistical power]] of the latter trial has been questioned,<ref>{{cite journal |vauthors=Van Cleave J, Kemper AR, Davis MM |title=Interpreting negative results from an underpowered clinical trial: warts and all |journal=Archives of Pediatrics & Adolescent Medicine |volume=160 |issue=11 |pages=1126–9 |date=November 2006 |pmid=17088515 |doi=10.1001/archpedi.160.11.1126 |doi-access=free }}</ref> and it has been suggested that duct tape occlusion therapy only works with rubber-based adhesives, whereas these studies utilized acrylic-based adhesive.<ref name =Samlaska>{{cite journal |last1= Samlaska |first1=Curt | year= 2012 |title= Response to 'Question 3 What is the efficacy of duct tape as a treatment for verruca vulgaris?' |journal= Archives of Disease in Childhood|volume=96 |issue=9 |pages=897–899 |doi=10.1136/archdischild-2011-300533 |pmid=21836182|s2cid=206853952 }}</ref> |
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== Focht's procedure == |
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{{how to|date=April 2014}} |
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# Cut duct tape as close to the size of the wart as possible and apply it over the wart |
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# Keep it on for 6 days (if the tape falls off for any reason, quickly replace it with a new bit) |
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# On the evening of the 6th day, take the duct tape off |
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# Wash and soak the foot and debride the wart with an emery board or pumice stone |
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# Leave the wart exposed for this one night |
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# Next morning, re-apply some new duct tape and wait until the evening of the 7th day before removal |
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The procedure should repeat week-by-week up to about 2 months. |
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==Follow-up studies used different duct tape== |
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Two other studies failed to repeat the success Focht et al. Despite serious flaws in these subsequent studies, they have called into question whether duct tape is effective for treating warts, particularly in the comprehensive meta analyses that have been conducted.<ref name="Gibbs2003" /><ref name="kwok2012" /> The most obvious flaw in both of these studies is that they did not use regular{{specify|date=April 2014}} duct tape, they instead choose a clear version of duct tape which has a completely different adhesive, namely acrylic based as opposed to rubber based (as pointed out by Wenner et al,<ref name ="wenner">{{cite journal |author=Wenner R, Askari SK, Cham PM, Kedrowski DA, Liu A, Warshaw EM |title=Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial |journal=Archives of Dermatology |volume=143 |issue=3 |pages=309–13 |date=March 2007 |pmid=17372095 |doi=10.1001/archderm.143.3.309 }}</ref> and subsequently noted by Curt Samlaska, Assistant Professor of Medicine, University of Nevada School of Medicine, in response to a further review of these findings which failed to take this into account).<ref name =Samlaska>{{cite journal |last1= Samlaska |first1=Curt | year= 2012 |title= Response to 'Question 3 What is the efficacy of duct tape as a treatment for verruca vulgaris?' |journal= Archives of Diseases in Childhood|volume=96 |issue=9 |pages=897–899 |publisher=British Medical Journal |doi=10.1136/archdischild-2011-300533 |url=http://adc.bmj.com/content/96/9/897/reply |accessdate=24 August 2013 |pmid=21836182}}</ref> Even the earliest work in this field suggested the glue on the tape may be why this treatment works <ref name = "litt1978" /> so it is perhaps not surprising that different results are found when using different kinds of tape. |
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A study led by Rachel Wenner into the effectiveness of duct tape occlusion compared its effect with a control group that used moleskin.<ref name ="wenner" /> In fact, in the treatment group using duct tape, moleskin was applied over the duct tape so that the patient couldn't visually tell if they were treated with duct tape or just moleskin. The huge flaw in this experiment was that regular duct tape was not used. They instead choose to use clear duct tape, which has a different glue to regular duct tape. Clear duct tape has an acrylic based glue and regular duct tape has a rubber based glue (as described by Wenner et al in their paper). Wenner also reports that the moleskin also has an acrylic based glue. So, Wenner's 2 treatment groups both used patches with acrylic based glue. It seems hardly surprising that there was no statistically significant difference in results reported between the 2 groups.{{opinion|date=April 2014}} |
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A second trial also used the same 3M clear duct tape for the treatment group which has an acrylic-based glue as described by Wenner.<ref name="wenner" /> They too found only modest but non-significant effect on wart resolution.<ref name="de haen">{{cite journal |author=de Haen M, Spigt MG, van Uden CJ, van Neer P, Feron FJ, Knottnerus A |title=Efficacy of duct tape vs placebo in the treatment of verruca vulgaris (warts) in primary school children |journal=Archives of Pediatrics & Adolescent Medicine |volume=160 |issue=11 |pages=1121–5 |date=November 2006 |pmid=17088514 |doi=10.1001/archpedi.160.11.1121 | url= http://archpedi.ama-assn.org/cgi/content/abstract/160/11/1121}}</ref> The [[statistical power]] of the latter trial has been questioned.<ref>{{cite journal |author=Van Cleave J, Kemper AR, Davis MM |title=Interpreting negative results from an underpowered clinical trial: warts and all |journal=Archives of Pediatrics & Adolescent Medicine |volume=160 |issue=11 |pages=1126–9 |date=November 2006 |pmid=17088515 |doi=10.1001/archpedi.160.11.1126 |url=http://archpedi.ama-assn.org/cgi/content/full/160/11/1126}}</ref> |
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A ''[[Popular Mechanics]]'' article found 3M transparent duct tape to have a "lackluster grip"<ref name="popular mechanics">{{cite journal |author=Sawyers, Harry|title=What's the Best Tape? Abusive Lab Test |journal=Popular Mechanics |date=February 2009 | url= http://www.popularmechanics.com/technology/gadgets/tests/4306415}}</ref>{{reliable source|date=April 2014}} which corresponds to DeHaen's finding that only 19% of respondents found the stickness of a transparent duct tape "good".<ref name = "de haen" /> |
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== Conclusion == |
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Studies have provided an indication that duct tape occlusion therapy can be effective in treating warts (particularly Focht et al). <ref name="focht02" /> Some medical advice now suggests duct tape to their patients as a treatment for warts and verrucas.<ref name="nhs" /><ref name="patient.co.uk" /><ref name="aad" /><ref name="bupa" /><ref name="demichele" /><ref name="mayo" /><ref name="detroit" /> |
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Other studies, like that of Wenner <ref name="wenner" /> and <ref name="de haen" /> have not found 'duct tape' to be effective but on scrutiny of their published papers it is clear that the "duct tape" they used was not a standard duct tape - it was clear tape and had a different glue than regular duct tape. These studies, which failed to replicate the results of Focht et al, have been widely cited, e.g. in the Cochrane meta analyses,<ref name="Gibbs2003" /><ref name="kwok2012" /> though these subsequent citations do not take account of the different duct tape used in these trials. |
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Further studies are necessary to properly confirm the effectiveness of this treatment. |
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==See also== |
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*[[Plantar warts]] |
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==References== |
==References== |
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{{reflist| |
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{{DEFAULTSORT:Duct Tape Occlusion Therapy}} |
{{DEFAULTSORT:Duct Tape Occlusion Therapy}} |
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Latest revision as of 00:24, 2 October 2024
Duct tape occlusion therapy (DTOT) is a method of treating warts by covering them with duct tape for prolonged periods.
The manner in which duct tape appears to work is unclear.[1] The tape might create a macerating and keratolytic environment, stimulating an immune response.[1] The type of adhesive in the duct tape is likely to be important as leeching of the adhesive into the skin may be causing the immune system response.[2] Side effects can include skin irritation and peeling.[3]
There is mixed evidence that occlusive treatment with various types of duct tape is effective.[1] Clinical trials in 2012 concluded that no statistically significant difference between clear duct tape and placebo could be determined within the sample.[1] On health information websites, duct tape is referred to as a treatment with mixed evidence of efficacy, no good evidence or described as alternative medicine.[3][4][5][6][7]
Despite the mixed evidence for efficacy, the simplicity of the method and its limited side-effects leads some researchers to be reluctant to dismiss it.[8]
Evidence
[edit]In 1978, Jerome Z Litt was the first to suggest that adhesive tape could be used to treat warts on the fingers. He claimed: "My method is safe, easy, simple, painless, inexpensive, and highly effective. It leaves no scarring or deformed nails. The mystery remains: How and why does this method work? I cannot offer any reasonable or logical explanation. It cannot be all 'hypnotic' or 'suggestive.' Could it be that the airtight occlusion and a chemical reaction set up by the adhesive in the tape might combine to release a chemical or 'toxin' causing the formation of antibodies? Whatever it may be, it works. I recommend that you try it."[9]
A 2002 study involved 51 individuals (aged 3–22) treated with either "standard duct tape" (not otherwise specified in the study) or cryotherapy. A piece of duct tape was cut as close to the size of the wart as possible, and applied to the area. The tape was left on for 6 days and replaced with new duct tape if it fell off. After 6 days, the tape was removed, the area soaked in water, and the wart debrided with an emery board or pumice stone. The tape was left off overnight and reapplied on the following morning. This process continued for up to 2 months or until the wart was resolved, whichever occurred first. Progress was monitored every 4 weeks. The researchers found the duct tape treatment significantly more effective than the cryotherapy (P=0.05) with 85% in the duct tape treatment group having a complete resolution of their wart, compared to 60% in the cryotherapy group.[10] The study was criticized due to lack of a placebo control group,[11] and because a number of outcome assessments were done by phone.[12] There was also no reported long term follow up to ensure no recurrence of the warts.[11][10]
Two later studies failed to repeat the results of the 2002 study.[13][14] One compared duct tape with moleskin, finding no statistically significant difference in results reported between the two groups.[14] Both studies used 3M clear duct tape, again concluding no statistically significant effect on wart resolution.[13] The statistical power of the latter trial has been questioned,[15] and it has been suggested that duct tape occlusion therapy only works with rubber-based adhesives, whereas these studies utilized acrylic-based adhesive.[2]
References
[edit]- ^ a b c d Kwok, CS; Gibbs, S; Bennett, C; Holland, R; Abbott (2012). "Topical treatments for cutaneous warts". Cochrane Database of Systematic Reviews. 9 (9): CD001781. doi:10.1002/14651858.CD001781.pub3. PMC 8101088. PMID 22972052.
- ^ a b Samlaska, Curt (2012). "Response to 'Question 3 What is the efficacy of duct tape as a treatment for verruca vulgaris?'". Archives of Disease in Childhood. 96 (9): 897–899. doi:10.1136/archdischild-2011-300533. PMID 21836182. S2CID 206853952.
- ^ a b "Warts and verrucas - Treatment". nhs choices. Retrieved August 24, 2013.
- ^ "Warts and Verrucas". patient.info. www.patient.info. Retrieved August 24, 2013.
- ^ "How to get rid of warts". American Academy of Dertmatology. Retrieved August 24, 2013.
- ^ "Warts and Verrucas". Bupa. Retrieved August 24, 2013.
- ^ Mayo Clinic Staff. "Plantar Warts". The Mayo Clinic. Retrieved August 24, 2013.
- ^ Stubbings, Alison; Wacogne, Ian (2011-09-01). "Question 3 What is the efficacy of duct tape as a treatment for verruca vulgaris?". Archives of Disease in Childhood. 96 (9): 897–899. doi:10.1136/archdischild-2011-300533. ISSN 0003-9888. PMID 21836182. S2CID 206853952.
- ^ Litt, J. Z (1978). "Don't excise--exorcise. Treatment for subungual and periungual warts". Cutis. 22 (6): 673–6. PMID 720133.
- ^ a b Focht DR, Spicer C, Fairchok MP (October 2002). "The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart)". Archives of Pediatrics & Adolescent Medicine. 156 (10): 971–4. doi:10.1001/archpedi.156.10.971. PMID 12361440.
- ^ a b Williams, Hywel (2003). "Commentary on 'Duct tape occlusion treatment increased resolution in common paediatric warts'". Evidence Based Medicine. 8 (2): 58. doi:10.1136/ebm.8.2.58.
- ^ Gibbs, S; Harvey, I; Sterling, JC; Stark, R (2003). Gibbs, Sam (ed.). "Local treatments for cutaneous warts". Cochrane Database of Systematic Reviews (3): CD001781. doi:10.1002/14651858.CD001781. PMID 12917913.
- ^ a b de Haen M, Spigt MG, van Uden CJ, van Neer P, Feron FJ, Knottnerus A (November 2006). "Efficacy of duct tape vs placebo in the treatment of verruca vulgaris (warts) in primary school children". Archives of Pediatrics & Adolescent Medicine. 160 (11): 1121–5. doi:10.1001/archpedi.160.11.1121. PMID 17088514.
- ^ a b Wenner R, Askari SK, Cham PM, Kedrowski DA, Liu A, Warshaw EM (March 2007). "Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial". Archives of Dermatology. 143 (3): 309–13. doi:10.1001/archderm.143.3.309. PMID 17372095.
- ^ Van Cleave J, Kemper AR, Davis MM (November 2006). "Interpreting negative results from an underpowered clinical trial: warts and all". Archives of Pediatrics & Adolescent Medicine. 160 (11): 1126–9. doi:10.1001/archpedi.160.11.1126. PMID 17088515.