ABSTRACT

Objective  To determine if application of duct tape is as effective as cryotherapy in the treatment of common warts.

Design  A prospective, randomized controlled trial with 2 treatment arms for warts in children.

Setting  The general pediatric and adolescent clinics at a military medical center.

Patients  A total of 61 patients (age range, 3-22 years) were enrolled in the study from October 31, 2000, to July 25, 2001; 51 patients completed the study and were available for analysis.

Intervention  Patients were randomized using computer-generated codes to receive either cryotherapy (liquid nitrogen applied to each wart for 10 seconds every 2-3 weeks) for a maximum of 6 treatments or duct tape occlusion (applied directly to the wart) for a maximum of 2 months. Patients had their warts measured at baseline and with return visits.

Main Outcome Measure  Complete resolution of the wart being studied.

Results  Of the 51 patients completing the study, 26 (51%) were treated with duct tape, and 25 (49%) were treated with cryotherapy. Twenty-two patients (85%) in the duct tape arm vs 15 patients (60%) enrolled in the cryotherapy arm had complete resolution of their warts (P = .05 by χ²analysis). The majority of warts that responded to either therapy did so within the first month of treatment.

Conclusion  Duct tape occlusion therapy was significantly more effective than cryotherapy for treatment of the common wart.

COMMENT

In our study we found that the simple application of duct tape was more effective than cryotherapy in the treatment of the common wart. Cutaneous warts are a common diagnosis in the pediatric population, and many therapies exist for the treatment of these warts. Anecdotal reports have suggested the effectiveness of tape occlusion therapy. However, this is the first randomized, prospective study on the efficacy of tape occlusion therapy for warts. We also found that the warts that ultimately responded to tape therapy typically showed at least partial resolution after 2 to 3 weeks of treatment. Warts that were unchanged in appearance by the 3-week mark were unlikely to respond.

Several potential benefits exist for using duct tape over cryotherapy. Duct tape is more practical for parents and patients to use, especially when compared with the multiple clinic visits required for freezing of a wart. In today’s busy society, it can be difficult for parents to keep follow-up appointments every 2 weeks for cryotherapy of their children’s warts. In our study, the lower success rate of the cryotherapy arm is likely partially attributable to longer-than-optimal intervals between treatments in some patients. There was better compliance with the prescribed treatment regimen within the duct tape group, primarily due to the ease of administration. Another benefit of tape occlusion therapy is that it is much less costly than cryotherapy. The treatment can be undertaken in the home using inexpensive duct tape. Finally, tape occlusion therapy appears to be less threatening to a young child than freezing. The use of duct tape for the treatment of warts was generally well received by our patients.

Although both cryotherapy and tape occlusion therapy are well-tolerated treatments, the adverse-effect profile for tape occlusion therapy appears to be better. A variety of adverse effects with cryotherapy of warts have been previously reported, including pain during the procedure, erythema, hemorrhagic blister formation, dyspigmentation, recurrence of the wart, infection, and nail dystrophy when treating periungual warts.⁶ Although most patients tolerate the cryotherapy well, children 6 years and younger will typically remember previous applications as painful.¹² In our study, all patients in the cryotherapy arm experienced pain, and 1 young child actually vomited in fear of pain before each application. The only adverse effect observed in the duct tape group during our study was a minimal amount of local irritation and erythema. Practical considerations limiting the use of duct tape therapy include difficulty for some patients in keeping the tape on, potential for exacerbation of underlying skin conditions such as eczema, and the cosmetic impracticality of using duct tape on the face.

Our study had several limitations. Because some parents were reluctant to make a return clinic visit if the wart had resolved, we did not have follow-up measurements of many of the warts in the clinic and had to rely on parental report of resolution over the telephone. This was more frequent in the duct tape arm because therapy in that arm took place in the home. To minimize this problem, we requested that parents closely examine the child for any residual wart. There was also difficulty in obtaining timely follow-up for many patients, which made our secondary end point of time to resolution more imprecise.

Our study indicates that duct tape is an effective treatment for warts that can be used as an alternative treatment to cryotherapy. Location of the wart might be related to efficacy of therapy. Our treatment arms were comparable in baseline location of the warts, but the relatively small number of patients in each treatment arm prevented us from determining whether wart locations made a difference in response to the occlusion therapy. We observed that some patients treated with duct tape had resolution of other untreated warts following elimination of the treated wart. We hypothesize this to be secondary to stimulation of the host’s immune system. Although our study was not designed to investigate the efficacy of treating one wart in the resolution of multiple warts, this would be an area for further investigation.

In conclusion, although many therapies exist for the eradication of warts, the use of duct tape appears promising as a safe and nonthreatening treatment modality for children. In our study, duct tape occlusion therapy was shown to be more effective than cryotherapy in the treatment of verruca vulgaris, and it caused few adverse effects.

Source: JAMA