Duct tape occlusion therapy: Difference between revisions
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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. A review of 52 trials, concluded, "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> The history of [[randomized controlled trials]] (RCTs) into viral warts as been described 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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== History == |
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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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__TOC__ |
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== Evidence == |
== Evidence == |
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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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The strongest evidence of the efficacy of duct tape occlusion therapy in the treatment of warts comes from a 2002 study.<ref name="focht02">{{cite journal |author=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 |url=http://archpedi.jamanetwork.com/article.aspx?articleid=203979}}</ref> 51 children/young adults from aged 3 to 22 were treated with either "standard duct tape" (not otherwise specified in the study) or [[cryotherapy]] (liquid nitrogen). |
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The procedure was to cut a piece of duct tape as close to the size of the wart as possible, and apply it to the art. The patient (or patrent) was told to leave the tape on for six days, replacing with a new piece if the original piece fell off. After six days, the patient was told to remove the tape, soak the area in water, and debride the wart with an emery board or pumice stone, after which the tape was left off overnight and reapplied on the following morning. This treatment continued for up to two months or until the wart was resolved, whichever occurred first. Patients were requested to return to the clinic for follow-up every four weeks so progress could be monitored.<ref name="focht02"/> |
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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 cryotheraphy group. |
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There are various criticisms of this study, including the lack of a [[placebo group|placebo (control) group]]<ref name = "williams2003" /> and 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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Notwithstanding these criticisms, this study gives the clearest indication that standard duct tape, with rubber based adhesive, has a positive effect on treating warts. |
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Two later studies failed to repeat the success this study. 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.<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><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> 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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Another study 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. The moleskin also has an acrylic based glue. So both treatment groups used patches with acrylic based glue. There was no statistically significant difference in results reported between the 2 groups. |
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A second trial also used the same unidentified 3M clear duct tape for the treatment group which has an acrylic-based glue.<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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== Conclusion == |
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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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Some studies suggest that duct tape occlusion therapy may be effective in treating warts. <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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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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Other studies,<ref name="wenner" /><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 the above study, 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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==References== |
==References== |
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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.