University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• In pediatric patients, is duct tape occlusion therapy as effective as cryotherapy with liquid nitrogen in the treatment of the common wart?

Clinical Bottom Lines

1. 5-10% of all pediatric patients have warts caused by human papillomaviruses, which accounts for a large number of office visits each year.
   
2. No prior randomized controlled trials, only ancedotal reports of duct tape efficacy.
   
3. Resolution of the wart occured in 22/26 (85%) of patients in the duct tape arm vs 15/25 (60%) in the cryotherapy arm (p=0.5) within the follow up period of 2 months 1.
4. Relative Risk Reduction is then 62% and Absolute Risk Reduction is 25% with a Number Needed to Treat of 4 patients.
5. Duct tape less expensive, less painful, has fewer side effects, and requires fewer office visits than cryotherapy.
   

Summary of Key Evidence

1. Sixty-one patients, age 3-22 years who presented with complaint of wart at an Army Medical Center Clinic were randomized to either cryotherapy or duct tape.1
   
2. Cyrotherapy arm received liquid nitrogen for 10 seconds every 2-3 weeks until resolution of wart for a maximum of 6 treatments. Parents told to debrid wart one day prior to return visit for cryotherapy.
   
3. Duct tape arm had duct tape applied in clinic and then left on for 6 days. After 6 days, tape removed and wart debrided by parents. Tape left off overnight and then reapplied the next morning. Treatment continued until resolution of wart for a maximum of 2 months.
   
4. Size of wart measured by medical personnel blinded to treatment arm.
   
5. Resolution of the wart occured in 22/26 (85%) of patients in the duct tape arm vs 15/25 (60%) in the cryotherapy arm (p=0.05) within the follow up period of 2 months.
   

Additional Comments

• Initial sample size small (61) and then 9 lost to follow up and 1 excluded from study after losing study wart. Loss of 16% of patients may be significant.2
• Follow up time of only 2 months is relatively short, as other studies have shown recurrence up to 6 months.3
• Duct tape arm had no side effects compared to several observed side effects in cryotherapy arm.
• Several studies have shown no real benefit of cryotherapy over simple OTC topical treatments (salicylic acid),4 further supporting duct tape which is less inexpensive and has fewer side effects than even OTC meds.
• Two-thirds of all common warts resolve spontaneously in 2 years so is treatment really neccessary?

Citation

1. Focht DR, Spicer C, Fairchok MP. The Efficacy of Duct Tape vs Cryotherapy in the Treatment of Verruca Vulgaris (the Common Wart). Arch Pediatr Adolesc Med 2002; 156: 971-974.
2. Ringold S, Mendoza JA, Tarini BA, Sox C. Is Duct Tape Occlusion Therapy as Effective as Cryotherapy for the Treatment of the Common Wart? Arch Pediatr Adolesc Med 2002;156:975-977.
   
3. Torrelo A. What's New in the Treatment of Viral Warts in Children? Pediatric Dermatology 2002;19(3):191-9.
   
4. Gibbs S, Harvey I, Sterling JC, Stark R. Local treatments for cutaneous warts (Cochrane Review). In: The Cochrane Library, Issue 1 2003. Oxford: Update Software.

CAT Author: Julia E. Madison, MD

CAT Appraisers: Robert Schumacher, MD

Date appraised: December 16, 2002