Warts removed by vitamin D injection - many studies

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Vitamin D injection cleared 80% of palmoplantar warts (adding CO2 laser cured 90%) – May 2023

Comparative Study Among CO2 Laser, Intralesional Vitamin D3, and Combined Intralesional Vitamin D3 and CO2 Laser in Treatment of Palmoplantar Warts
Dermatol Surg. 2023 May 31. doi: 10.1097/DSS.000000000000384
Dina Ahmed El Sharkawy 1, Hanan Rabea Nada, Sahar Radman Al-Kubati

Background: Many therapeutic modalities are used for palmoplantar warts; whether destructive, such as chemical cautery, electrocautery, cryocautery, surgical removal, and laser ablation, or immunotherapeutic, stimulating the immune system against the virus such as intralesional vitamin D3 injection.

Objective: To compare the efficacy of intralesional vitamin D injection combined with CO2 laser to the efficacy of either modality alone.

Patient and methods: Eighty age- and sex-matched patients with palmoplantar warts were divided into 4 groups:

• Group A received intralesional vitamin D3 injections,
• group B received ablative CO2 laser,
• group C received CO2 laser and intralesional vitamin D3 injection, and
• group D (control group) were injected intralesionally with normal saline.

Assessment was performed clinically, photographically, and dermoscopically before and after treatment to evaluate the response, and then, another assessment was performed after 3 months to detect any recurrence.

Results: Complete clearance was seen in

• 90% of cases in group C, in
• 80% in group A, and in
• 75% in group B

with no statistically significant difference.

Conclusion: Intralesional vitamin D, CO2 laser, and the combination show comparable efficacy and recurrence rates. Intralesional vitamin D maybe a better option for people with a relative contraindication to CO2 laser.

References

1. Kaur GJ, Brar BK, Kumar S, Brar SK, et al. Evaluation of the efficacy and safety of oral isotretinoin versus topical isotretinoin in the treatment of plane warts: a randomized open trial. Int J Dermatol 2017;56:1352–8.
2. Silverberg NB. Human papillomavirus infections in children. In: Schroten H, Wirth S, editors. Pediatric Infectious Diseases Revisited. Basel: Birkhäuser; 2007; pp. 365–90.
3. Hemmatian Boroujeni N, Handjani F. Cryotherapy versus CO2 laser in the treatment of plantar warts: a randomized controlled trial. Dermatol Pract Concept 2018;8:168.‏73.
4. Sefcik RS, Burkhart CG. Wart immunotherapies: a short review. Open Dermatol J 2017;11:30–4.
5. Nguyen J, Korta DZ, Chapman LW, Kelly KM, et al. Laser treatment of nongenital verrucae: a systematic review. JAMA Dermatol 2016;152:1025–34.
6. Conforti C, Vezzoni R, Giuffrida R, Fai A, et al. An overview on the role of CO2 laser in general dermatology. Dermatol Ther 2021; 34, e14692‏.
7. Asnaashari M, Zadsirjan S. Application of laser in oral surgery. J lasers Med Sci 2014;5:97–107.
8. Fathy G, Sharara MA, Khafagy AH. Intralesional vitamin D3 versus Candida antigen immunotherapy in the treatment of multiple recalcitrant plantar warts: a comparative case–control study. Dermatol Ther 2019;32:e12997‏.
9. AlGhamdi K, Kumar A, Moussa N. The role of vitamin D in melanogenesis with an emphasis on vitiligo. Indian J Dermatol Venereol Leprol 2013; 79:750–8.
10. Liu PT, Stenger S, Li H, Wenzel L, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006;311:1770–3.
11. Aktaş H, Ergin C, Demir B, Ekiz Ö. Intralesional vitamin D injection may be an effective treatment option for warts. J Cutan Med Surg 2016;20:118–22.
12. Raghukumar S, Ravikumar BC, Vinay KN, Suresh MR, et al. Intralesional vitamin D3 injection in the treatment of recalcitrant warts: a novel proposition. J Cutan Med Surg 2017;21:320–4.
13. Kavya M, Shashikumar BM, Harish MR, Shweta BP. Safety and efficacy of intralesional vitamin D3 in cutaneous warts: an open uncontrolled trial. J Cutan Aesthet Surg 2017;10:90–4.
14. Abou‐Taleb DA, Abou‐Taleb HA, El‐Badawy O, Ahmed AO, et al. Intralesional vitamin D3 versus intralesional purified protein derivative in treatment of multiple warts: a comparative clinical and immunological study. Dermatol Ther 2019; 32:e13034‏.
15. Montecino-Rodriguez E, Berent-Maoz B, Dorshkind K. Causes, consequences, and reversal of immune system aging. J Clin Invest 2013;123:958–65.
16. Läuchli S, Kempf W, Dragieva G, Burg G, et al. CO2 laser treatment of warts in immunosuppressed patients. Dermatology 2003;206:148–52 ‏.
17. Mitsuishi T, Sasagawa T, Kato T, Iida K, et al. Combination of carbon dioxide laser therapy and artificial dermis application in plantar warts: human papillomavirus DNA analysis after treatment. Dermatol Surg 2010;36:1401–5‏.
18. Rasi A, Soltani-Arabshahi R, Khatami A. Cryotherapy for anogenital warts: factors affecting therapeutic response. Dermatol Online J 2007;13:2.
19. Sgonc R, Gruber J. Age-related aspects of cutaneous wound healing: a mini-review. Gerontology 2013;59:159–64.
20. Kawano Y, Egawa K, Egawa G, Egawa N, et al. Spontaneous regression of genital warts at untreated sites following electrocoagulation treatment for lesions at the other sites. J Dermatol 2020;47:e46–e47.
21. Serour F, Somekh E. Successful treatment of recalcitrant warts in pediatric patients with carbon dioxide laser. Eur J Pediatr Surg 2003;13:219–23.
22. Leung L. Treating common warts: options and evidence. Aust Fam Physician 2010; 39: 933–7.‏

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Vitamin D injection cured a variety of warts on skin - 2017 A

Intralesional Vitamin D3 Injection in the Treatment of Recalcitrant Warts: A Novel Proposition.
J Cutan Med Surg. 2017 Apr 1:1203475417704180. doi: 10.1177/1203475417704180.
Raghukumar S1, Ravikumar BC1, Vinay KN1, Suresh MR1, Aggarwal A1, Yashovardhana DP1.
1 Department of Dermatology, Hassan Institute of Medical Sciences, Hassan, Karnataka state, India.

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.

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Vitamin D injection cured a variety of warts on skin - 2017 B

Safety and efficacy of intralesional vitamin D3 in cutaneous warts: An open uncontrolled trial
J Cutan Aesthet Surg 2017;10:90-4 Year : 2017 | Volume : 10 | Issue : 2 | Page : 90-94
Manjunath Kavya, Basavapura Madegowda Shashikumar, Muddanahalli Rajegowda Harish, Bhadbhade P Shweta
Department of Skin and STD, Mandya Institute of Medical Sciences, Mandya, Karnataka, India
Two images in study via Google Images

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.

 Download the PDF from VitaminDWiki

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Warts eliminated in 80 percent of those getting vitamin D injection – Aug 2015

• Warts eliminated by vitamin D injections

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67% of warts cleared by Vitamin D injections - Jan 2020

Comparative clinical study of the efficacy of intralesional MMR vaccine vs intralesional vitamin D injection in treatment of warts
Journal of Cosmetic Dermatology https://doi.org/10.1111/jocd.13272
Dalia R. Shaldoum MBBCh Ghada F. R. Hassan MD Eman H. El Maadawy MD Gamal M. El‐Maghraby MD

Background: Many therapeutic modalities were reported for the treatment of warts; however, no single treatment is completely effective.

Objective: To evaluate the efficacy of intralesional injection of MMR vaccine vs vitamin D in treatment of warts.

Patients and Methods
A total of 60 patients were included in the study divided into two groups. Group A received intralesional MMR vaccine into largest wart, and group B received intralesional vitamin D3 into each lesion with maximum of five warts treated in one session. A maximum of six sessions was done every 3 weeks in both groups. Follow‐up was done for 6 months for any recurrence.

Results
In group A: complete response in 80%, partial response in 6.67%, minimal response in 6.67%, and no response in 6.67% of patients. About 60% of patients with multiple warts showed complete clearance of distant untreated warts.
In group B: complete response in 66.7%, partial response in 6.67%, minimal response in 20%, and no response in 6.67% of patients.
There was no significant difference between both groups. No recurrence was observed in both groups in the follow‐up period.

Conclusions
Immunotherapy by both intralesional MMR vaccine and vitamin D3 is simple, well‐tolerated, effective, and cost‐benefit modalities for the treatment of warts.

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Intralesional Vitamin D3 treats of Cutaneous Warts- 2021

Role of Intralesional Vitamin D3 in the Treatment of Cutaneous Warts
Year : 2021 | Volume : 14 | Issue : 4 | Page : 404-408
Insha Latif1, Javeed Sultan2, Aaqib Aslam2, Iffat Hassan2, Reeta Devi2
1 Medical Officer (Dermatologist), District Hospital Ganderbal, Kashmir, J&K, India
2 Post Graduate Department of Dermatology, Venereology and Leprosy, Government Medical College (GMC), Srinagar, Jammu and Kashmir, India

Background: Cutaneous warts are common benign skin lesions caused by human papillomavirus. Various treatment options are available for these but immunotherapy is becoming more and more popular over the past few years. It stimulates cell-mediated immunity causing clearance of warts.

Aims and Objectives: The aim is to determine the role of intralesional vitamin D3 in the treatment of warts. Materials and Methods: Consecutive patients with verruca vulgaris attending OPD were included. Around two to three warts were injected first with 0.2 mL of lignocaine (20 mg/mL). After a few minutes, the same warts were injected with 0.2 mL (4 U) of vitamin D3 (15 mg/mL). The injections were given2 weeks apart for a maximum of six sessions, and the patient was followed up 3 months after the last injection.

Results: A total of 41 patients of cutaneous warts completed the study.

• Complete clearance was seen in 27 (65.85%) patients,
• partial response was seen in 11 (26.83%) patients, and three patients
• (7.32%) showed no response at all.

The mean number of injections required for complete response was four. Recurrence was seen in two patients (4.88%) and one patient had keloid formation at the sight of injection.
Limitation: This is a small sample sized study and lacks a control group.

Conclusion: Intralesional vitamin D3 is an effective treatment option for common warts.
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Wart removal: 85% by Duck Tape, 60% by Cyrotherapy - but later study disagreed - 2002

Dr. Greger video

• The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart) - 2002 DOI: 10.1001/archpedi.156.10.971 FREE PDF
• Silver duct tape occlusion in treatment of plantar warts in adults: Is it effective? - March 2020 https://doi.org/10.1111/dth.13342 FREE PDF
  • This test found cyrotheraphy to be MUCH BETTER thatn duck tape 58% vs 20%
• Duct tape for warts in children - Should nature take its course? May 2019 FREE PDF
  • With duct tape therapy, apply a small piece of duct tape directly on the wart once every 4 to 7 days; then remove the tape, clean the area with soap and water, and remove the dead skin using an emery board. Apply another piece of tape 12 hours later. Repeat this cycle for 4 to 6 weeks.

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See also web

• Wart Wikipedia
  " Warts are typically small, rough, and hard growths that are similar in color to the rest of the skin”
  “Warts are caused by infection with a type of human papillomavirus (HPV)”
  “The estimated current rate of non-genital warts among the general population is 1–13%”
• 40% of warts eliminated by Vitamin D injection, but less in smokers Jan 2019 10.1111/dth.12816
• How To Treat Recalcitrant Plantar Warts 2013
  “The treatment of warts can be very challenging.”
  “ Many warts fail to respond to conventional treatment and after several months are considered recalcitrant.”
  “Warts (verrucae) involve the epithelium of the skin and are caused by infection with the human papillomavirus (HPV). Warts are the most common viral infection of the skin, affecting 7 to 10 percent of the general population.”
• Close to Half of American Adults Infected With HPV, Survey Finds New York Times, April 2017
   Download the PDF with nice charts from VitaminDWiki
• Could 25-OH vitamin D deficiency be a reason for HPV infection persistence in cervical premalignant lesions? ResarchGate, PDF online
• Association Between Serum 25-Hydroxyvitamin D Level and Human Papillomavirus Cervicovaginal Infection in Women in the United States June 2016
• Successful Treatment of Anogenital Wart with a Topical Vitamin D3 Derivative in an Infant April 2010]
  Successful for an infant, as well as elderly - taking weeks to months, free PDF online
• TAKING A LOOK AT USING VITAMINS TO CURE THE COMMON WART Oct 2017
  Vitamin A with or without salicylic acid
• How to Get Rid of Warts Naturally Dr. Axe; perhaps 20 ways, does not mention Vitamin D

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