Duct tape occlusion therapy

Duct tape occlusion therapy (DTOT): is a method for treating warts by keeping them covered with duct tape for an extended period. The putative mechanism is not well understood and is likely a result of stimulation of the host immune system.^[1] Similar treatments involving silicone gel sheets are often used with hypertrophic scars, also with an unknown method of action.

Procedure

Litt reported that adhesive tape left in place for 6½ days and then removed for 12 hours before the cycle was repeated was successful in treating periungual and subungual warts.^[2][3]

1. Place a piece of duct tape on the lesion.
2. Leave the tape in place for 6½ days (156 hrs), replacing any duct tape that falls off with a new piece as soon as possible.
3. After 6½ days, remove tape. Gently debride the lesions with a pumice stone or emery board.
4. Leave off for 12 hrs, then apply a new piece of duct tape to begin another 6½ day cycle for up to two months or until the wart is gone.

Effectiveness

Duct tape occlusion therapy is not yet proven to be effective, with some studies showing some effectiveness, and others finding no significant efficacy. One study by Focht et al. found that the duct tape method was 85% effective, compared to a 60% success rate in the study's cryotherapy group.^[4]

Another study led by Rachel Wenner, however, found no statistically significant effect in a double-blind, randomized and controlled clinical trial in 90 adults when transparent duct tape was compared to moleskin.^[5] There was no statistically significant difference for resolution of the target wart between patients treated with moleskin versus patients treated with duct tape. Eight of 39 patients (21%) in the treatment group vs 9 of 41 patients in the control group [22%] had complete resolution of the target wart. Fewer of the patients achieving resolution of their wart in the moleskin group had recurrence of their wart.

Of the patients who had complete resolution, 6 (75%) in the treatment group and 3 (33%) in the control group had recurrence of the target wart by the sixth month. "Whether or not the standard type of duct tape is effective is up in the air," said co-author Dr. Rachel Wenner of the University of Minnesota, who started the new study as a medical student. "Theoretically, the rubber adhesive could somehow stimulate the immune system or irritate the skin in a different manner."^[6] Since Wenner's study protocol covered the adhesive with waxed paper, the treatment did not achieve the combination of airtight occlusion and a reaction to the adhesive suggested by Litt in his paper as the mechanism of action.^[7]

A second trial found duct tape had a modest but nonsignificant effect on wart resolution.^[8] The statistical power of the latter trial has been questioned.^[9]

One randomized controlled trial found that more people having occlusive treatment with duct tape than cryotherapy had complete clearance of warts at two months. The randomized controlled trial did not assess recurrence.^[10]

See also

• Plantar warts
• Duct tape

References

1. ^ Common wart self care by Mayo Clinic staff February 17, 2006
2. ^ Don't Excise - Exorcise - Treatment For Subungual And Periungual Warts
3. ^ The Efficacy of Duct Tape vs Cryotherapy in the Treatment of Verruca Vulgaris (the Common Wart)
4. ^ 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. http://archpedi.ama-assn.org/cgi/pmidlookup?view=long&pmid=12361440. 
   reviewed in Miller KE (February 2003). "Duct tape more effective than cryotherapy for warts". American Family Physician 67 (3). http://www.aafp.org/afp/20030201/tips/8.html. ^{[dead link]}
   & DeMichele J (2003). "A new medical breakthrough: wart to do when verruca vulgaris attacks". Journal of Young Investigators 7 (5). http://www.jyi.org/volumes/volume7/issue5/features/demichele.html. 
5. ^ 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. 
6. ^ "Study Casts Doubt on Duct Tape Wart Cure". Newsmax, 21 March 2007.
7. ^ Litt JZ (December 1978). "Don't excise--exorcise. Treatment for subungual and periungual warts". Cutis 22 (6): 673–6. PMID 720133. 
8. ^ 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. http://archpedi.ama-assn.org/cgi/content/abstract/160/11/1121. 
9. ^ 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. http://archpedi.ama-assn.org/cgi/content/full/160/11/1126. 
10. ^ Duct tape occlusion in treatment of warts (subscription required), Clinical Evidence, British Medical Journal.