Duct tape occlusion therapy

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Duct tape occlusion therapy (DTOT) is a purported method of treating warts by covering them with duct tape for prolonged periods.

The way that duct tape might potentially 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 may also be important.[2] It may be a psychological effect that is more effective in children than adults.[1] Side effects are rare, although skin irritation may occur.[3] Cryotherapy (liquid nitrogen) has less risk of irritation than duct tape.[3]

There is no very convincing evidence that occlusive treatment with various types of duct tape is effective.[1] Two relatively recent trials concluded no statistically significant difference between clear duct tape and placebo.[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]

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." He also claimed that when there are multiple warts on different fingers they would all disappear if only one of the warts was treated with duct tape.[8]

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 cryotheraphy group.[9] The study was criticized due to lack of a placebo control group,[10] and because a number of outcome assessments were done by phone.[11] There was also no reported long term follow up to ensure no recurrence of the warts.[10][12]

Two later studies failed to repeat the results the 2002 study.[13][14] One compared duct tape with moleskin, finding no statistically significant difference in results reported between the 2 groups.[14] The other 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]

  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 (Cochrane Skin Group) 9 (9): 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 (British Medical Journal) 96 (9): 897–899. doi:10.1136/archdischild-2011-300533. PMID 21836182. Retrieved 24 August 2013. 
  3. ^ a b c "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. ^ Mayo Clinic Staff. "Plantar Warts". The Mayo Clinic. Retrieved August 24, 2013. 
  8. ^ Litt JZ (December 1978). "Don't excise--exorcise. Treatment for subungual and periungual warts". Cutis 22 (6): 673–6. PMID 720133. 
  9. ^ 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. 
  10. ^ a b Williams, Hywel (2003). "Commentary on 'Duct tape occlusion treatment increased resolution in common paediatric warts'". Evidence Based Medicine (British Medical Journal) 8 (2): 58. doi:10.1136/ebm.8.2.58. Retrieved 24 August 2013. 
  11. ^ Gibbs, S; Harvey, I; Sterling, JC; Stark, R (2003). "Local treatments for cutaneous warts". Cochrane Database of Systematic Reviews (Cochrane Skin Group) (3). doi:10.1002/14651858.CD001781. Retrieved 24 August 2013. 
  12. ^ Miller KE (February 2003). "Duct tape more effective than cryotherapy for warts". American Family Physician 67 (3). 
  13. ^ 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. 
  14. ^ 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. 
  15. ^ 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.