Safety and efficacy of intralesional vitamin D3 in cutaneous warts: An open uncontrolled trial

Abstract

Background:Cutaneous warts are treated primarily with destructive methods such as cryotherapy or electrocautery. These modalities of treatment are time-consuming and may be associated with scarring in multiple warts. Immunotherapy is emerging as a new modality of treatment which acts on enhancing cell-mediated immunity against human papillomavirus for clearance of both treated and distant warts.Aims:This study aims to evaluate the safety and efficacy of intralesional Vitamin D3 for the treatment of cutaneous warts.Materials and Methods:Patients with multiple warts were selected for immunotherapy. Vitamin D3 (0.2 ml, 15 mg/ml) was injected to the base of warts after injecting with lignocaine (0.2 ml, 20 mg/ml). The injections were repeated 2 weeks apart for a maximum of 4 sessions or until complete clearance, whichever was earlier. A maximum of 2 warts were treated per session and patients were followed up for 6 months after the last injection.Results:Forty-two patients with multiple warts were recruited for the study who completed the 6-month follow-up period and were available for analysis. Of these, 23 had palmoplantar warts, 18 had verruca vulgaris and 1 patient had filiform wart. In total, 33 of 42 patients (78.57%) showed complete response, 6 patients (14.28%) showed moderate response and three patients (7.14%) showed mild response. Recurrence was observed in one patient with the palmoplantar wart. No serious adverse effects were reported.Limitations:Lack of control group was the main drawback in our study.Conclusion:Intralesional Vitamin D3 is safe and effective for treatment of multiple cutaneous warts.

Intralesional vitamin D3 versus intralesional purified protein derivative in treatment of multiple warts: A comparative clinical and immunological study

“…Later, Kavya et al () and Raghukumar et al () used IL vitamin D3 and reported complete clearance in 78.6% and 90% of patients, respectively. However, they injected larger volumes of vitamin D3 of higher concentration (0.2–0.5 mL of 15 mg/mL) in more than one wart at a time for four treatment sessions.…”

Intralesional vitamin D immunotherapy for recalcitrant molluscum contagiosum

“…This probable mechanism of intralesional vitamin D3 in MC may be similar to that postulated in warts such as regulating epidermal cell proliferation, differentiation, cytokine modulation, and toll‐like receptor‐mediated genetic induction of antimicrobial peptides (Aktaş et al, ; Kavya et al, ; Thappa & Chiramel, ). Although MMR vaccine immunotherapy has been reported successful in two cases of MC (Na, Kim, & Kim, ), we avoided it in our relatively immunosuppressed patients.…”

“…There are multiple treatment options available for MC, however, potential scarring from ablative procedures, the inconvenience and need for prolonged therapy with imiquimod, nonavailability of some immunogens (like Candida Antigen) and contraindication of mumps‐measles‐rubella (MMR), a live attenuated vaccine in immunosuppressed individuals, made us think out‐of‐the‐box to treat extensive MC in these immunosuppressed and relatively immunosuppressed patients with intralesional vitamin D immunotherapy. This novel approach was an extrapolation of the well‐documented use of vitamin D immunotherapy for cutaneous warts (Aktaş et al, ; Kavya et al, ).…”

“…This probable mechanism of intralesional vitamin D3 in MC may be similar to that postulated in warts such as regulating epidermal cell proliferation, differentiation, cytokine modulation, and toll-like F I G U R E 2 (a) Multiple lesions of molluscum over the face (and scalp) of a 42-year-old severely asthmatic male patient, relatively immunosuppressed due to long-term intake of daily inhaled steroids and occasional oral steroids; (b) Complete clearance of lesions after two sessions of intralesional vitamin D (7.5 mg/session) administered under local anesthesia, 4 weeks apart F I G U R E 3 (a) Multiple lesions of molluscum over the limbs, (as well as torso) in a 13-year-old girl with nephrotic syndrome on oral prednisolone, nonresponsive to topicals or oral ranitidine taken for upto 12 weeks; (b) Complete clearance of lesions after two sessions of intralesional vitamin D (7.5 mg/session) administered under local anesthesia, 4 weeks apart receptor-mediated genetic induction of antimicrobial peptides (Aktaş et al, 2016;Kavya et al, 2017;Thappa & Chiramel, 2016). Although MMR vaccine immunotherapy has been reported successful in two cases of MC (Na, Kim, & Kim, 2014), we avoided it in our relatively immunosuppressed patients.…”

“…However, these treatment options may have limitations when used for recurrent lesions or immunosuppressed patients. Intralesional vitamin D has been effectively used in the treatment of cutaneous warts (Aktaş, Ergin, Demir, Ekiz, & Intralesional Vitamin, ; Kavya, Shashikumar, Harish, & Shweta, ). We report the use of intralesional vitamin D immunotherapy in two cases of treatment recalcitrant MC.…”