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Duct tape occlusion therapy

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Duct tape occlusion therapy (DTOT) is a purported method of treating warts by keeping them covered with duct tape.

The way that duct tape might work is unclear.[1] The tape might create a macerating and keratolytic environment, stimulating an immune response.[1] It may be a psychological effect that is more effective in children than adults.[1] The type of adhesive in the duct tape may be important.[2]

There is no very convincing evidence that occlusive treatment with various types of duct tape is effective.[1] Two relatively recent trials concluded no significant difference between clear duct tape and placebo.[1] Duct tape is sometimes referred to as a potential treatment for verrucas and warts.[3][4][5][6][7][8]

Evidence

In 1978 Jerome Z Litt was the first to suggest that adhesive tape could be used to treat warts. He claimed: "My method is safe, easy, simple painless, inexpensive, and highly effective [...] 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][unreliable medical source?]

A 2002 study involving 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). 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 debridee 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 cryotheraphy 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 longer term follow up to ensure no recurrence of the warts. Further analysis and commentary of the study is available.[7][11][13]

Two later studies failed to repeat the success the 2002 study.[14][15] One compared duct tape with moleskin, finding no statistically significant difference in results reported between the 2 groups.[15] The other used 3M clear duct tape, again concluding no statistically significant effect on wart resolution.[14] The statistical power of the latter trial has been questioned,[16] 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

  1. ^ a b c d e Kwok, CS; Gibbs, S; Bennett, C; Holland, R; Abbott (2012). "Topical treatments for cutaneous warts". Cochrane Database of Systematic Reviews. 9 (9). Cochrane Skin Group: CD001781. doi:10.1002/14651858.CD001781.pub3. PMID 22972052. Retrieved 24 August 2013.
  2. ^ a b Samlaska, Curt (2012). "Response to 'Question 3 What is the efficacy of duct tape as a treatment for verruca vulgaris?'". Archives of Diseases in Childhood. 96 (9). British Medical Journal: 897–899. doi:10.1136/archdischild-2011-300533. PMID 21836182. Retrieved 24 August 2013.
  3. ^ "Warts and verrucas - Treatment". nhs choices. Retrieved August 24, 2013.
  4. ^ "Warts and Verrucas". www.patient.co.uk. Retrieved August 24, 2013.
  5. ^ "How to get rid of warts". American Academy of Dertmatology. Retrieved August 24, 2013.
  6. ^ "Warts and Verrucas". Bupa. Retrieved August 24, 2013.
  7. ^ a b Jennifer DeMichele (July 2003). "A New Medical Breakthrough: Wart to do when Verruca vulgaris Attacks". Journal of Young Investigators. Retrieved August 24, 2013.
  8. ^ Mayo Clinic Staff. "Plantar Warts". The Mayo Clinic. Retrieved August 24, 2013.
  9. ^ Litt JZ (December 1978). "Don't excise--exorcise. Treatment for subungual and periungual warts". Cutis. 22 (6): 673–6. PMID 720133.
  10. ^ 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. PMID 12361440.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ a b Williams, Hywel (2003). "Commentary on 'Duct tape occlusion treatment increased resolution in common paediatric warts'". Evidence Based Medicine. 8 (2). British Medical Journal: 58. doi:10.1136/ebm.8.2.58. Retrieved 24 August 2013.
  12. ^ Gibbs, S; Harvey, I; Sterling, JC; Stark, R (2003). "Local treatments for cutaneous warts". Cochrane Database of Systematic Reviews (3). Cochrane Skin Group. doi:10.1002/14651858.CD001781. Retrieved 24 August 2013.
  13. ^ Miller KE (February 2003). "Duct tape more effective than cryotherapy for warts". American Family Physician. 67 (3).
  14. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  15. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  16. ^ 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.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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