Effectiveness of Intralesional Vitamin D3 in Cutaneous Warts

Background: Verruca vulgaris is a common viral infection of the skin caused by human papillomavirus that often causes significant discomfort and embarrassment. Several destructive methods are available for treatment with variable success and may result in scarring, while less aggressive approaches can lead to lesion recurrence. Additionally, these local modalities are not practical for patients with a large number of warts. Much research were performed to evaluate the various immunomodulators intralesionally to treat cutaneous warts. Intralesional vitamin D3 has been reported as a successful treatment of warts.

Aims: To evaluate the efficacy of intralesional vitamin D3 treatment for cutaneous warts.

Materials and Methods: This study considered 36 patients aged between 18 and 70 years who presented with single or multiple cutaneous warts, varying in size and duration, and who had not received immunosuppression drugs 6 months before starting this study. About 0.2 to 0.5 mL of vitamin D3 solution (600,000 IU; 15 mg/mL) was injected at the base of the wart following a lidocaine (0.2 mL, 20 mg/mL) injection. A maximum of 5 warts would be treated in a session set at 4 weeks for a maximum duration of 4 treatments until resolution. Both pre-and two-month post-intervention standardized photographs were taken. Patients were followed for 6 months after the last injection to see if they had any recurrence. Response was later categorized into complete, partial, or no response. Complete clearance of the injected wart target was recorded in 33.3% of patients in the case group, while only 5% of patients did so in the control group (p ≤.001), and that was statistically significant. Therefore, intralesional injection of vitamin D3 may be a plausible and safe intervention for treating common warts. Clinical assessment was by photographic evaluation at baseline, before and after each treatment session, and on completion of treatment.

The results are presented below. A total of 36 patients with cutaneous warts were included in the study. Of the total number of patients, 24 (66.7%) were male and 12 (33.3%) were female. Among the 36 patients, 22 (61.1%) had palmoplantar warts, 10 (27.8%) had common warts (verruca vulgaris), and 4 (11.1%) had filiform warts. The mean age of the patients was 34.31±11.33 years (range, 18 to 58 years). A total of 12 patients (33.3%) exhibited complete clearance of the warts. Out of the total 22 patients with palmoplantar warts, complete clearance was observed in 6 (27.3%). In the group of 4 patients with filiform warts, complete clearance was observed in 3 (75%). In the group of 10 patients with verruca vulgaris, complete clearance was observed in 3 (30%), completing the clearing process at the fourth visit. Thus, of the 36 patients, 12 (33.3%) exhibited a complete response, 8 (22.2%) demonstrated a moderate response, 7 (19.4%) displayed no response, and 9 (25%) were classified as non-responders. Recurrences were observed in six patients (16.7%). Among these, five patients (83.5%) who smoked exhibited a higher recurrence rate. No serious adverse effects were reported.

Conclusion: Intralesional injection of vitamin D3 may be considered safe, effective, well-tolerated, easily administrated in outpatient clinics and an inexpensive treatment and safe modality for the treatment of common warts.

Limitations: Small study samples and lack of a control group was the main drawbacks in our study.