to the editor: I enjoyed the article on therapy for cutaneous warts¹ in the August 15, 2005, issue of American Family Physician. However, the authors did not discuss surgical excision of cutaneous warts. Many family physicians and surgeons still practice this therapeutic option in some parts of the world, especially in Africa, where the other methods are not readily available. I have had to surgically excise genital warts while practicing in Mozambique, one of the poorest countries in the world. Is there evidence to support the efficacy of this treatment method, or should it be considered completely outdated?

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.