to the editor: In their article,¹ "Cutaneous Warts: An Evidence-Based Approach to Therapy," Drs. Bacelieri and Johnson presented a well-organized and easy-to-follow evidence-based approach to common warts. However, I was mildly surprised that there was no mention of duct tape. In the February 1, 2003, issue of American Family Physician, the "POEMs and Tips from Other Journals" department presented a review² of an article³ in which the cure rates for common warts were statistically higher using duct-taping (85 percent of warts completely resolved) than for those treated with cryotherapy (65 percent of warts completely resolved).

In actual practice, I first counsel my patients about the benefits and drawbacks of salicylic acid, cryotherapy, and duct tape. Even though the cost of cryotherapy is higher and the cure rates may not be, most of my patients still seem to prefer that route. However, a handful never came back to see me after they decided to use duct tape to treat themselves.

in reply: The letters from Dr. Monjok and Dr. Viel made excellent points, and I would like to address each one separately.

In response to Dr. Monjok's question of whether surgical excision is still a viable option for warts: Surgical excision for warts is impractical as a cure because cutaneous warts are caused by a virus that often exists on normal appearing skin outside of the confines of the clinical wart. On multiple occasions, I have seen a "doughnut wart" or clinical wart around a surgical site. With that information, it is still a worthwhile practice to debulk a large clinical wart to improve patient comfort in areas of the world where more effective treatments are unavailable.

In reply to Dr. Viel, duct tape occlusion is an effective treatment for warts, as noted in the study by Focht and colleagues.¹ In my practice, I often use over-the-counter salicylic acid or prescription 40 percent urea gel under occlusion with duct tape for plantar warts. I personally find it difficult to use duct tape for common warts on other locations.