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Am Fam Physician. 2003;68(10):1912-1916

to the editor: We read with interest the recent article “Molluscum Contagiosum and Warts.”1 An adjunctive therapy for the treatment of warts that was not mentioned is duct tape occlusion therapy (DTOT). The hypothesized mechanism of action is stimulation of the host's immune system. There have been anecdotal reports2,3 of the efficacy of adhesive tape in the treatment of periungual and subungual warts, and one randomized study4 has shown that DTOT is significantly more effective than cryotherapy. In this study,4 85 percent of patients undergoing DTOT had complete resolution of the wart compared with only 60 percent of patients treated with cryotherapy. These investigators found no difference in the average time to resolution, but they did not collect data on wart recurrence after completion of the therapy.

The technique for DTOT in this study4 involved placing a piece of duct tape on the lesion. Patients were instructed to leave the tape in place for six days. Any duct tape that fell off was replaced with a new piece as soon as possible. After six days, the tape was removed and the wart was soaked in water. A pumice stone or emery board was used to debride the lesions. The next morning, a new piece of duct tape was applied to begin another six-day cycle. These researchers found that the majority (73 percent) of warts that would respond to DTOT (defined as seeing observable signs of resolution within the first two weeks of therapy) completely resolved within 28 days of initiating therapy.

DTOT is purported to be an inexpensive, tolerable, safe, and simple alternative to other forms of therapy to treat warts.5 The only reported adverse effects were local irritation and erythema. Also, DTOT may be a cosmetic impracticality on facial warts.4 An obvious clinical advantage of DTOT is in the treatment of warts in children, in whom DTOT could be used in lieu of cryotherapy, which can be painful.

Although there are many therapies to treat warts, DTOT is another alternative that should be considered. Larger randomized studies are needed to assess the effectiveness of DTOT on warts in varying anatomic locations, and longer follow-up periods will be necessary to assess the recurrence of warts following treatment with duct tape.6 Also, studies comparing DTOT with therapies other than cryotherapy would be useful. Several articles in the mass media have commented on the usefulness of duct tape for treating warts; therefore, physicians should expect that patients might inquire about duct tape during future office visits.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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