Verruca vulgaris, the common wart, is a general pediatric complaint affecting as many as five-to-ten percent of all pediatric patients. Although a very benign condition, few protuberances bother parents as much. The very name, Verruca vulgaris, sounds dreadful.
Warts are caused by a virus, the human papillomavirus, and can occur virtually anywhere there is skin. The peak age in the pediatric population is around 12-16 years. Interestingly, over 66 percent of ALL warts in children will resolve spontaneously within two years without any treatment. Regardless, warts are unsightly and parents want something done about them right away.
As a result, the list of “wart treatments” is a long and sometimes expensive one. The list includes cryotherapy (freezing), salicylic acid, hyfrecation (burning), cimetidine, cantharin, podophylin, carbon dioxide laser treatments, no treatments and tape occlusion. These various modalities report a success rate ranging from a meager 32 percent to a stellar 93 percent. But, the fact that there are so many various treatments leads one to conclude that there is not ONE BEST choice. In fact, many dermatologists will advise parents that if the wart is not of a cosmetic concern, leave it alone. The odds are better than not that it will go away on it’s own.
I came across an interesting article in a pediatric journal recently. The authors conducted a study whereby they had two groups of pediatric patients with warts. One group (25 patients) was treated with cryotherapy using liquid nitrogen to freeze the wart. The patients in this group were treated every two weeks for a total of six weeks, or until the wart disappeared. The patients in the duct tape group (26 patients) were instructed to cover the wart with standard duct tape for a total of six days. At the end of the sixth day, they were instructed to remove the duct tape and soak the area in warm water. Then gently debride the wart with a pumice stone or emery board to remove any dead or extra skin. The next morning they were instructed to re-apply the duct tape for another six days and repeat the routine for a total of two months.
The results were quite interesting. Of the 26 patients in the duct tape group, 22 or 85 percent had complete resolution of their warts by the end of the study. This compared to 15 or 60 percent of the 25 patients in the cryotherapy group. Some interesting observations about the study were that of the patients treated with duct tape. If there was going to be a response, it would be a favorable one noted by the first two weeks. Warts that seemed unchanged by three weeks of treatment were not likely to respond at all.
In the group treated with cryotherapy, it was important that the interval between treatments not exceed three weeks. The literature stated that when the freezing interval was increased from three to four weeks, there was a decrease in cure rate from 75 percent to 40 percent. The authors found that in spite of treating the warts with liquid nitrogen every two weeks, only a 60 percent cure rate was produced.
No one is certain how these modalities work in the treatment of warts. One theory is that the duct taping somehow stimulates the patient’s immune system through local irritation. Thus, the system recognizes the wart as a foreign body, attacking and killing it. An added support of this theory is the fact that some of the patients in the duct tape group had smaller warts elsewhere on their bodies. Even though these warts were not covered with duct tape, when the treated warts resolved, the others disappeared as well. This was also observed in the cryotherapy group.
The group treated with the duct tape had minimal side effects: the main complaint was local skin irritation, which posed little problem. The major concern was keeping the duct tape secured over the wart. The group treated with liquid nitrogen had more complaints. These included pain and burning at the site of freezing which ranged from mild to severe. The literature reported other side effects such as blistering, infection and skin discoloration. However, these were not reported in this particular study.
In conclusion, it is noted that Verruca vulgaris is a benign condition that is common in children, and over two-thirds of the cases will resolve completely without ANY treatment. Considering the results published in this study, it seems very practical and reasonable to try the duct tape approach as a first line treatment for the common wart.