Evaluation of therapeutic effectiveness of vitamin D3 injections in common warts in a tertiary care centre
Keywords:Immunotherapy, Vitamin D3, Warts, Normal saline, Intralesional
Background: Warts or verrucae are the benign cutaneous manifestations caused by human papilloma virus. The treatment of wart possess a therapeutic challenge, as a result multiple modalities are existing for the treatment of cutaneous warts, which is cumbersome and may result in cosmetic disfigurement, chances of recurrences. The aim of the present study was to determine the resolution of common warts in response to vitamin D3 injections and to compare the resolution of common warts in the group receiving vitamin D3 with placebo group receiving normal saline.
Methods: A total of 26 patients were enrolled and divided into Group A- received lesional injection of 0.2 ml vitamin D3 every 3 weeks for 3 months for the improvement in the size of warts. Group B- received 0.2 ml of normal saline injections as a control. The maximum of three sessions were carried in both groups. Clinical assessment was done by photographic evaluation at baseline, before each treatment session, and after completion of treatment.
Results: In group A, 76.92% (10) of the patients showed complete clearance of wart with vitamin D3 injection, while in group B 8% (1) of patients with normal saline showed partial response. This therapy was well tolerated except for the minimal side effects like pain, redness and swelling at the site of injection.
Conclusions: Intralesional Vit D3 injections may be a treatment option for warts, which has a good cosmetical acceptance and simple, well tolerated easily administrated in outpatient clinic rather than conventional treatment.
Leung L. Recalcitrant nongenital warts. Australian family physician. 2011;40(1/2):40.
Jabłońska S, Majewski S, Obalek S, Orth G. Cutaneous warts. Clin Dermatol. 1997;15(3):309-19
Kwok CS, Holland R, Gibbs S. Efficacy of topical treatments for cutaneous warts: a meta‐analysis and pooled analysis of randomized controlled trials. Br J Dermatol. 2011;165(2):233-46.
Ahn CS, Huang WW. Imiquimod in the treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol. 2014;15(5):387-99.
Meena JK, Malhotra AK, Mathur DK, Mathur DC. Intralesional immunotherapy with mycobacteriumw vaccine in patients with multiple cutaneous warts: Uncontrolled open study. JAMA Dermatol. 2013;149(2):237-9.
Daulatabad D, Pandhi D, Singal A. BCG vaccine for immunotherapy in warts: is it really safe in a tuberculosis endemic area? Dermatol Therap. 2016;29(3):168-72.
Na CH, Choi H, Song SH, Kim MS, Shin BS. Two‐year experience of using the measles, mumps and rubella vaccine as intralesional immunotherapy for warts. Clinical Experimental Dermatol. 2014;39(5):583-9.
Majid I, Imran S. Immunotherapy with intralesional Candida albicans antigen in resistant or recurrent warts: A study. Indian J Dermatol. 2013;58(5):360.
Muñoz Garza FZ, Roé Crespo E, Torres Pradilla M, Aguilera Peirò P, Baltà Cruz S, Hernández Ruiz ME, Baselga Torres E. Intralesional Candida antigen immunotherapy for the treatment of recalcitrant and multiple warts in children. Pediatric Dermatol. 2015;32(6):797-801.
Lynch MD, Cliffe J, Morris-Jones R. Management of cutaneous viral warts. BMJ. 2014;348:3339.
Vender R, Bourcier M, Bhatia N, Lynde C. Therapeutic options for external genital warts. J Cutaneous Med Surg. 2013;17(6):61-7.
Nofal A, Nofal E, Yosef A, Nofal H. Treatment of recalcitrant warts with intralesional measles, mumps, and rubella vaccine: a promising approach. Int J Dermatol. 2015;54(6):667-71.
Chandrashekar L. Intralesional immunotherapy for the management of warts. Indian J Dermatol Venereol Leprol. 2011;77(3):261.
Imagawa I, Suzuki H. Successful treatment of refractory warts with topical vitamin D3 derivative (maxacalcitol, 1α, 25‐dihydroxy‐22‐oxacalcitriol) in 17 patients. J Dermatol. 2007;34(4):264-6.
Aktaş H, Ergin C, Demir B, Ekiz Ö. Intralesional Vitamin D injection may be an effective treatment option for warts. J Cutaneous Med Surg. 2016;20(2):118-22.
Labandeira J, Vázquez‐Blanco MA, Paredes C, Suárez‐Peñaranda JM, Toribio J. Efficacy of topical calcipotriol in the treatment of a giant viral wart. Pediatric Dermatol. 2005;22(4):375-6.
Rind T, Oiso N, Kawada A. Successful treatment of anogenital wart with a topical vitamin D3 derivative in an infant. Case Rep Dermatol. 2010;2(1):46-9.
Shaheen MA, Salem SA, Fouad DA, El‐Fatah AA. Intralesional tuberculin (PPD) versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: a comparative clinical and immunological study. Dermatologic Therap. 2015;28(4):194-200.
Zamanian A, Mobasher P, Jazi GA. Efficacy of intralesional injection of mumps-measles-rubella vaccine in patients with wart. Advanced Biomed Res. 2014;3.
Kavya M, Shashikumar BM, Harish MR, Shweta BP. Safety and efficacy of intralesional vitamin D3 in cutaneous warts: An open uncontrolled trial. J Cutaneous Aesthetic Surg. 2017;10(2):90.