May 31, 2017
Journal of cutaneous medicine and surgery
TAKE-HOME MESSAGE
- In this study, intralesional injections of 0.2- to 0.5-mL vitamin D3 solution (600,000 IU; 15 mg/mL) at 3-week intervals were used to treat recalcitrant warts in 60 patients. The majority of patients (90%) had complete response. Of the remaining patients, 6.66% showed partial response and 3.33% showed no response. Complete resolution required an average of 3.66 injections. Of the 35% of patients with distant warts, all experienced complete resolution of these in addition to resolution of the primary lesion.
- This study showed for the first time that intralesional injections of vitamin D3, which regulates cell proliferation and antimicrobial peptide formation, may be used in the treatment of extragenital recalcitrant warts.
– InYoung Kim, MD, PhD
Abstract
BACKGROUND
Verruca vulgaris (viral warts) is a fairly common condition with a plethora of treatment options having variable success rates. Recalcitrant warts are refractory to treatment with often disappointing response and high recurrence rates. Lately, treatment with intralesional injections has gained momentum due to its effectiveness in clearing warts by stimulating the cell-mediated immunity. Vitamin D, when applied topically, regulates epidermal cell proliferation and is involved in the formation of antimicrobial peptides. We have attempted to use vitamin D3 to exploit its reported action as an immunotherapeutic molecule in addition to its topical effects. To our knowledge, there are no reports of intralesional vitamin D3 injections used in the treatment of extragenital recalcitrant warts.
METHODS
Sixty-four patients with recalcitrant warts of varying sizes and duration were included in the study. About 0.2- to 0.5-mL vitamin D3 solution (600,000 IU, 15 mg/mL) was injected to the base of the wart. A maximum of 5 warts were injected per session at 3-week intervals until resolution or for a maximum of 4 treatments. Patients were followed up for 6 months after the last injection to detect any recurrence.
RESULTS
Sixty patients completed the study. Complete response was seen in 54 of 60 (90%), partial response in 4 of 60 (6.66%), and no response in 2 of 60 (3.33%). The average number of injections required to achieve a complete resolution was 3.66. Complete resolution of distant warts was noticed in all patients.
CONCLUSIONS
Intralesional vitamin D3 is a safe, effective, and an inexpensive treatment option for recalcitrant warts.
Journal Abstract
Story Source – may require registration at site
These authors are to be commended for hypothesizing and investigating a novel approach to the treatment of warts. I am a big proponent of intralesional immunotherapy for the treatment of warts because of epitope unveiling and stimulation of the immune system. I am intrigued that injection of vitamin D “cured” 90% of people with recalcitrant warts, including plantar warts. The authors presented their patient population and statistical analysis well. They also reviewed other injection studies using other agents.
They injected vitamin D into multiple warts every 3 weeks. An average of three to four injections was needed. I am skeptical that there may have been a traumatic component because up to five warts were injected. In many immunotherapy studies, including mine, only one wart would be injected. It makes sense that there would be a higher response rate when more warts are injected. Anyway, I am optimistic and excited to see injections of vitamin D studied further, both alone and in combination. Kudos to these authors. Hopefully, eventually, we will be able to help every person develop immunity to HPV (and all infections).