Re:Don't Excise -- Exorcise
We'd like to thank Dr Litt for informing us that he was the first to comment on this treatment method (1) and apologise for having missed this in our review (2). We would, however, add that the function of a short evidence-based review like Archimedes is to weigh the evidence for the treatment, and in particular look at when it has been subjected to trials. Harsh as it might seem, this sadly rarely includes the initial discovery of a therapy. We can see that with hindsight it might have been polite if we had included a very brief mention of the original observation in our opening line of our conclusion, and we would certainly endeavour to to this if we publish further on this subject.
References 1. Litt JZ. Abstract Dont excise--exorcise. Treatment for subungual and periungual warts. Cutis. 1978 Dec; 22(6): 673-6. 2. Stubbings A, Wacogne I. Question 3. What is the efficacy of duct tape as a treatment for verrucas vulgaris? Arch Dis Child. 2011; 96: 897-9.
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Re:Clear duct tape based wart studies are flawed
Thank you, Prof Samlaska, for your response to our article (1). It is indeed interesting the difference between traditional and clear duct tape, and this is something that we did not consider in our review. It would be worth noting however, that I think it is unlikely that the families to whom this treatment is suggested would consider this difference either.
I agree more work should be done looking at this therapeutic intervention, and naturally we would be happy to repeat this short review in a few years when further work has been done.
Reference 1. Stubbings A, Wacogne I. Question 3. What is the efficacy of duct tape as a treatment for verrucas vulgaris? Arch Dis Child. 2011; 96: 897-9.
Conflict of Interest:
Clear duct tape based wart studies are flawed
I read with much interest the article by Stubblings and Wacogne 1 on the efficacy of topical treatment for cutaneous warts with duct tape. Duct tape is a polyethylene reinforced multipurpose pressure sensitive tape with a soft and flexible shell and pressure sensitive adhesive.2 There are three layers consisting of a polyisoprene-based adhesive, a fabric reinforcement (scrim) and a polyethylene backing. Clear duct tape is a completely different product than traditional duct tape and is more like clear Scotch brand tape with a fabric reinforced scrim. When applied to the skin, traditional duct tape provides a waterproof physical barrier over the infected area.3
Focht et al 4 treated common warts in 61 patients with either cryotherapy or duct tape occlusion. After 2 months, 85% of patients in the duct tape arm vs 60% in the cryotherapy arm had complete resolution of their warts. Subsequent studies by de Haen et al 5 and Wenner et al 7 used clear duct tape and showed no statistically significant response rates. Clear duct tape is not the same product proven so effective by Focht et al. It is likely that the success of traditional duct tape is associated with the rubber-based adhesive, which also contains tackifiers, that comes in direct contact with the wart during treatment. The only conclusion one can reach from the two studies using clear duct tape is that the mechanism of action is most likely not related to occlusion or simple debridement.
Stubbings and Wacogne do not mention this basic difference in the duct tape products utilized in these three studies. Unless otherwise proven, the use of two completely different adhesives that come directly in contact with the wart tissue, should be considered different treatment modalities since the adhesive may be the active ingredient. These three trials4,5,6 should not be pooled in meta-analysis studies or in any statistical analysis on the efficacy of topical treatments for cutaneous warts.3 All future studies should use traditional polyisoprene-based adhesive tape.
There is another reason to seriously consider duct tape as a therapeutic option. It is widely accepted that latex condoms prevent the transmission of a variety of sexually transmitted diseases (STD), including papilloma, HIV, and herpes viruses.7,8 The mechanism is one of a physical waterproof barrier, preventing direct contact of infected tissues with a susceptible host. To my knowledge, duct tape is the only potential treatment option that provides a waterproof protective barrier, similar to a condom. This may help prevent transmission of the virus to loved ones or other potential contacts.
References 1. Stubbings A, Wacogne I. Question 3. What is the efficacy of duct tape as a treatment for verruca vulgaris? Arch Dis Child. 2011;96:897-9. 2. http://en.wikipedia.org/wiki/Duct_tape. 3. Samlaska C. Clear duct tape is not duct tape. Br J Dermatol 2011;165:432-3. 4. Focht DR III, 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;156:971-4. 5. de Haen M, Spigt MG, van Uden P, Feron FJM, Knottnerus A. Efficacy of duct tape vs placebo in the treatment of verruca vulgaris (warts) in primary school children. Arch Pediatr Adolesc Med 2006;160:1121-5. 6. Wenner R, Askari SK, Cham PMH, Kedrowski DA, Liu A, Warshaw EM. Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial. Arch Dermatol 2007;143:309-13. 7. Sulak PJ. Sexually transmitted diseases. Semin Reprod Med 2003;21:399-414. 8. Goon P, Sonnex C. Frequently asked questions about genital warts in the genitourinary medicine clinic: an update and review of recent literature. Sex Transm Infect 2008;84:3-7.
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Don't Excise -- Exorcise
Dermatologists around the world are commenting on the article published in the Archives of Diseases in Children, 2011;96(9):897-899 They are commenting specifically to me, who had written an article, published 34 years ago, in the journal Cutis, 1978;Dec; 22(6);673-6 titled "Don't Excise--Exorcise," the PubMed number for which is 720133. Look it up . . . (The Abstract is below.")
In their Search Strategy and Outcome, the authors revealed that they used a Secondary Source and Primary Sources. Under the Secondary Sources they say that they had searched, among other resources, PubMed. Well, they didn't search long enough or hard enough. It was like the blind leading the blind. They went on to quote Gibbs, et al, Focht, et al, de Haen, et al, and Werner, et al., none of whom ever had the courtesy to check on the seminal observation, if you wish to call it that, on the treatment of subungual and periungual warts with tape in 1978 that I had written and that had been published. From 1951 until the 1980s, I had used adhesive tape; this segued into duct tape several years later. Shame on these sources . . .
If everyone had only the smarts to check Wikipedia, he/she could have also found the Cutis reference there! Shouldn't some type of acknowledgement be given me in your journal? Or a response from the authors at least?
Jerome Z. Litt, MD
Cutis. 1978 Dec;22(6):673-6. Abstract Don't excise--exorcise. Treatment for subungual and periungual warts. Litt JZ. "I offer yet another modality from that "bag of tricks" used in the management of the common wart, primarily the subungual and periungual varieties, where treatment can be painful, and where the undesirable sequelae of scarring and nail deformities may occur. My method is safe, easy, simple, painless, inexpensive, and highly effective. It leaves no scarring or deformed nails. When there are multiple warts on different digits, occlusion of only one wart by this method often results in cure of all. 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." PMID: 720133 [PubMed - indexed for MEDLINE]
Addendum: The treatment is remarkably straightforward: apply the tape, covering the wart completely and leave on for 7 days (actually 6.5 days). Remove for 12 hours; repeat as necessary. My results have been excellent, with photos of proof. They must follow this to the letter 6+ on; 12 hours off . . .
No pain; no burning; no itching; no adverse side effects; no scarring; no monetary expense (I give each patient a roll of Duck Tape [a proprietary tape - about 19 different colors; no financial interest!]). Just phone calls to let me know how things are progressing. Occasionally, I see the patient every 3 or 4 weeks and dab on 1% Gentian Violet on each wart. The younger set love the color; I tell them it's a special wart "medicine." Some of them show it in school for "Show & Tell."
Conflict of Interest: