Intralesional vitamin D3 vs purified protein derivative in treatment of recalcitrant cutaneous and venereal warts

Abstract

Introduction Human papilloma virus (HPV) can produce a significant amount of anxiety and stress in patients. Many therapeutic options are available for treating warts. More recent and effective treatment, including intralesional immunotherapy, have been tried in the recent times with variable success rates. Aim The aim was to compare the efficacy, safety, and the clinical response of intralesional vitamin D3 (Vit D3) vs purified protein derivative (PPD) in the treatment of recalcitrant cutaneous and venereal warts. Patients and methods This study was carried out on 30 patients with cutaneous and venereal recalcitrant warts. Fifteen patients (11 patients with recalcitrant cutaneous warts and four patients with recalcitrant venereal warts) were subjected to intralesional injection of Vit D3 in one up to three warty lesions in every patient; the other 15 patients (11 patients with recalcitrant cutaneous warts and four patients with recalcitrant venereal warts) were subjected to intralesional injection of PPD in one up to 15 warty lesions in every patient. Assessment of the results was done by clinical evaluation, patient satisfaction, and multiple digital photographs. Results We found that the total response rate to immune therapy was 83.3% in both groups of patients collectively. In the Vit D3-treated group, complete response was achieved in 73.3% of patients and partial response in 26.6%. However, in the PPD-treated group, complete response was achieved in 46.6% of patients, partial response in 20%, and 33.3% of the patients showed no response. The overall clinical response in Vit D3-treated group was significantly higher than in the PPD-treated group (100 vs 66.67%, respectively). We also found that the longer the duration of HPV infection, the poorer the response rate to treatment and the need for more sessions. Conclusion Clinical efficacy and safety of intralesional injection of Vit D3 vs PPD for treatment of HPV, the high response rate, the absence of adverse effects, low cost, and the affordability of the Vit D-treated group makes it a very useful tool in the treatment of HPV and is more superior than the PPD.