How to Cite
Abstract
Objective
To assess the efficacy of intralesional vitamin D3 injection as a treatment modality for recalcitrant warts in a tertiary care setting in Pakistan.
Materials and Methods
This quasi-experimental study was carried out in the Department of Dermatology, CMH Lahore, over six months from March 16 to September 16, 2021. After obtaining approval from the hospital's ethical and research committee, 139 patients aged 18–60 years, presenting with recalcitrant warts fulfilling the inclusion criteria, were recruited. Intralesional vitamin D3 (600,000 IU/mL), 0.5ml was injected into the base of up to four warts per session, with injections repeated every two weeks for a maximum of four sessions. Efficacy was defined as the complete resolution of all warts. Adverse events were monitored, and data were stratified by age, gender, and wart characteristics.
Results
The study population had a mean age of 30.3 ± 6.8 years, with a male predominance (57.6%). The average wart duration was 6.5 ± 1.5 months. Complete resolution was achieved in 89.9% of patients. While no statistically significant differences in efficacy were observed across stratified subgroups (p > 0.05), patients with shorter wart durations (3–6 months) demonstrated the highest success rate (98.7%), whereas those with warts lasting longer than 6 months showed the lowest response (79.0%). Adverse effects were minimal and resolved on their own, with 15% of patients experiencing injection site pain and 10% reporting temporary erythema.
Conclusion
Intralesional vitamin D3 injections have demonstrated significant efficacy and a favorable safety profile, positioning it as a promising and novel treatment for recalcitrant warts. However, to strengthen the evidence and better understand its long-term benefits, additional randomized controlled trials are essential.
References
Lynch MD, Cliffe J, Morris-Jones R. Management of cutaneous viral warts. BMJ [Internet]. 2014 May 27;348(may27 8):g3339. Available from: http://dx.doi.org/10.1136/bmj.g3339
Hogendoorn GK, Bruggink SC, de Koning MNC, Eekhof JAH, Hermans KE, Rissmann R, et al. Morphological characteristics and human papillomavirus genotype predict the treatment response in cutaneous warts. Br J Dermatol [Internet]. 2018 Jan;178(1):197-205. Available from: http://dx.doi.org/10.1111/bjd.16180
de Koning MNC, Quint KD, Bruggink SC, Gussekloo J, Bouwes Bavinck JN, Feltkamp MCW, et al. High prevalence of cutaneous warts in elementary school children and the ubiquitous presence of wart-associated human papillomavirus on clinically normal skin. Br J Dermatol [Internet]. 2015 Jan;172(1):196-201. Available from: http://dx.doi.org/10.1111/bjd.13216
Zhu P, Zhang Y, Yang R, et al. Clinical guideline for the diagnosis and treatment of cutaneous warts. J Evid Based Med. 2022 Sep;15(3):284-301. Available from: http://dx.doi.org/10.1111/jebm.12494
Friedman PC. Management of difficult-to-treat warts: traditional and new approaches. Am J Clin Dermatol. 2021;22(3):379-94. Available from: https://doi.org/10.1007/s40257-020-00582-4
Chaudhary M, Brar A, Agarwal P, Chavda V, Jagati A, Rathod SP. A study of comparison and evaluation of various intralesional therapies in cutaneous warts. Indian Dermatol Online J. 2023;14(5):487-92. Available from: https://doi.org/10.4103/idoj.idoj_492_22
Ockenfels HM. Therapeutic management of cutaneous and genital warts. J Dtsch Dermatol Ges. 2016;14(9):892-9. Available from: https://doi.org/10.1111/ddg.12838
Al-Balat W, Abdel-Mawgoud Othman E, Samir Awad M. Intralesional antigen immunotherapy of warts: Review article. Zagazig Univ Med J [Internet]. 2024 Jan 8;0(0):0-0. Available from: http://dx.doi.org/10.21608/zumj.2024.257378.3065
Aldahan AS, Mlacker S, Shah VV, Kamath P, Alsaidan M, Samarkandy S, et al. Efficacy of intralesional immunotherapy for the treatment of warts: a review of the literature. Dermatol Ther [Internet]. 2016 Mar;29(3):197-207. Available from: http://dx.doi.org/10.1111/dth.12352
Martens PJ, Gysemans C, Verstuyf A, Mathieu C. Vitamin D's effect on immune function. Nutrients [Internet]. 2020 Apr 28;12(5):1248. Available from: http://dx.doi.org/10.3390/nu12051248
Salman S, Ahmed MS, Ibrahim AM, Mattar OM, El-Shirbiny H, Sarsik S, et al. Intralesional immunotherapy for the treatment of warts: a network meta-analysis. J Am Acad Dermatol. 2019;80(4):922-30.e4. Available from: https://doi.org/10.1016/j.jaad.2018.07.003
Ju HJ, Park HR, Kim JY, Kim GM, Bae JM, Lee JH. Intralesional immunotherapy for non-genital warts: a systematic review and meta-analysis. Indian J Dermatol Venereol Leprol. 2022;88(6):724-37. Available from: https://doi.org/10.25259/IJDVL_1369_20
Raghukumar S, Ravikumar BC, Vinay KN, Suresh MR, Aggarwal A, Yashovardhana DP. Intralesional vitamin D3 injection in the treatment of recalcitrant warts: a novel proposition. J Cutan Med Surg. 2017 Jul-Aug;21(4):320-4. Available from: http://dx.doi.org/10.1177/1203475417704180
Al-Sabak H, Al-Hattab M, Al-Rammahi M, Al-Dhalimi M. The efficacy of intralesional vitamin D3 injection in the treatment of cutaneous warts: a clinical therapeutic trial study. Skin Res Technol [Internet]. 2023 Aug;29(8):e13442. Available from: http://dx.doi.org/10.1111/srt.13442
Sharma G, Sharma S. Efficacy of intralesional immunotherapy with vitamin D3 injection in cutaneous warts: a clinical observational study. Clin Dermatol Rev [Internet]. 2023 Jul;7(3):272-6. Available from: http://dx.doi.org/10.4103/cdr.cdr_36_22
Sorour NE, Elesawy FM, Abdou AG, Abdelazeem SE, Akl EM. Intralesional injection of vitamin D in verruca vulgaris increases cathelicidin (LL37) expression: therapeutic and immunohistochemical study. J Dermatol Treat. 2022;33(3):291-6. Available from: https://doi.org/10.1080/09546634.2020.1750554
Eldahshan RM, Ashry WMO, Elsaie ML. Comparative study between intralesional injection of MMR, BCG, and Candida albicans antigen in treatment of multiple recalcitrant warts. J Cosmet Dermatol. 2022;21(4):1120-6. Available from: https://doi.org/10.1111/jocd.14737
Abdel Razik LH, Obaid ZM, Fouda I. Intralesional Candida antigen versus intralesional vitamin D3 in the treatment of recalcitrant multiple common warts. J Cosmet Dermatol. 2021;20(10):3341-6. Available from: https://doi.org/10.1111/jocd.14335
Prathibha JP, Varghese N, Aithal VV. Intralesional vitamin D3 versus bleomycin for difficult-to-heal palmoplantar warts: a comparative study. J Cutan Aesthet Surg [Internet]. 2023 Apr;16(2):114-20. Available from: http://dx.doi.org/10.4103/jcas.jcas_128_21
Ringin S. The effectiveness of cutaneous wart resolution with current treatment modalities. J Cutan Aesthet Surg [Internet]. 2020;13(1):24-8. Available from: http://dx.doi.org/10.4103/jcas.jcas_62_19
Mullen SA, Myers EL, Brenner RL, Nguyen KT, Harper TA, Welsh D, et al. Systematic review of intralesional therapies for cutaneous warts. J Invest Dermatol Innov. 2024;10:100264. https://doi.org/10.1016/j.xjidi.2024.100264
Mohta A, Kushwaha RK, Agrawal A, Sharma MK, Gautam U, Jain SK. Evaluation of the efficacy of intralesional measles, mumps, and rubella vaccine with intralesional vitamin D3 as immunotherapies in the treatment of recalcitrant cutaneous warts in adults—a randomized placebo-controlled study. Indian Dermatol Online J. 2021;12(6):879-887. https://doi.org/10.4103/idoj.idoj_573_20
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