Intralesional Vitamin D3 Injection Research Articles

Intralesional vitamin D3 versus intralesional triamcinolone acetonoid in patchy alopecia areata: a comparative clinical and dermoscopic study

ABSTRACT Background Alopecia areata (AA) is a common autoimmune T-cell mediated non-scarring, form of hair loss. It affects people of all ages and sexes. Aim To compare the efficacy of intralesional vitamin D3 injection versus that of intralesional triamcinolone acetonide in the treatment of patchy alopecia areata. Patients and methods This clinical study was carried on 40 adult patients with patchy alopecia areata, the patients were categorized into two groups. Group I involved 20 patients who received 1 ml of intralesional injection of vitamin D3 (cholecalciferol aqueous preparation 200 000 IU/2 ml) every 4 weeks for a maximum of three sessions. Group II involved 20 patients who received 1 ml of intralesional injection of triamcinolone acetonide 40 mg/mL every 4 weeks for a maximum of three sessions. Clinical and trichoscopic evaluations were done at the baseline, each session and for 3 months after the last session. Results There was no statistically significant difference between the two studied groups regarding the degree of clinical improvement (p = .8). A statistically significant reduction in AA specific trichoscopic signs was detected at the end of the sessions and after 3 months of follow-up in both groups, without any statistically significant difference between them. Also a statistically significant difference was found between both groups regarding the reported adverse effects with a significant better patient satisfaction encountered toward the intralesional vitamin D3 injection. Conclusion Intralesional vitamin D3 is a promising effective, simple, safe, and inexpensive, therapeutic modality for patchy AA.

Efficacy of intralesional vitamin D3 injection in the treatment of palmoplantar and periungual warts

Efficacy of intralesional vitamin D3 injection in the treatment of palmoplantar and periungual warts

Therapeutic Effects of Intralesional Injection of Vitamin D3 in Treatment of Recalcitrant Warts: An Evaluator-Blinded Clinical Trial

Background: Viral warts are a prevalent infection that affects people all over the world. Unfortunately, there is no proven antiviral treatment for them. Recalcitrant warts are also difficult to resolve and deciding on a strategy for their treatment is challenging. Recently immunotherapy modalities have led to desired treatment outcomes in patients. This study investigated the efficacy of vitamin D injection (as an immunotherapeutic agent) in the treatment of recalcitrant warts. Methods: In this clinical trial study, 40 patients were divided into two groups: the first group (intervention group) received cryotherapy with an intralesional injection of vitamin D3 (0.1 cc of vitamin D3 (300000 IU/1mL) per lesion and a maximum of 0.5 cc per session), and the second group (control group) received just cryotherapy. In each treatment session, patients were evaluated for treatment responses and any side effects. Each patient received four treatment sessions at 2-week intervals. Results: After 4 treatment sessions, the rate of response in the intervention group and the group that received just cryotherapy was 95.33%±5.87 and 76.67%±25.14, respectively, and this difference was significant (P<0.01). Furthermore, 57% (26 out of 45) of the lesions in the intervention group were completely resolved after 4 sessions, and the rest showed a moderate response to this treatment. Moreover, the minimum response rate was 80% in the intervention group and 30% in the control group. Conclusion: In recalcitrant skin warts, intralesional injection of vitamin D3 combined with cryotherapy significantly increased the treatment response and reduced the financial burden imposed on patients. The limitation of this trial was the small sample size of patients without a follow-up plan after completing the treatment sessions. Trial registration: The Iranian Registry of Clinical Trials registered this study (identifier: IRCT20200513047434N1).

(R.) "Efficacy of Intralesional Injection of Vitamin D3 in treatment of Alopecia Areata"

(R.) "Efficacy of Intralesional Injection of Vitamin D3 in treatment of Alopecia Areata"

Comparative Study Among CO2 Laser, Intralesional Vitamin D3, and Combined Intralesional Vitamin D3 and CO2 Laser in Treatment of Palmoplantar Warts.

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

Comparative study on the effectiveness of intralesional Measles, Mumps, and Rubella vaccine and intralesional vitamin D3 injection in the treatment of verruca

Background: Human papillomavirus (HPV) is the causative agent of verruca and is contagious, recurrent, and recalcitrant due to defects in cell-mediated immunity. No single mode of treatment is completely effective. The most commonly used treatment options are destructive and lead to scarring. The emerging new modality of treatment is immunotherapy, which acts by enhancing cell-mediated immunity (CMI) against HPV to clear treated as well as remote warts. Objectives: The objective was to compare the efficacy of intralesional Measles, Mumps, and Rubella (MMR) vaccine and intralesional vitamin D3 in cutaneous warts. Materials and Methods: A randomized, hospital-based, single-blind study on forty patients divided into two groups (groups A and B), comprising twenty patients each, was conducted. In group A, intralesional MMR vaccine 0.5 mL was injected into the base of warts. In group B, intralesional vitamin D3 0.5 mL was injected into the base of warts after achieving local anesthesia. Sessions were performed in two-week intervals for a maximum number of five sessions. The patients were followed for sixteen weeks. Results: In group A (MMR vaccine), a complete response was seen in 75% (15/20) of the patients, a moderate response in 15% (3/20), a partial response in 5% (1/20), and no response in 5% (1/20). In group B (vitamin D3), a complete response was seen in 65% (13/20) of the patients, a moderate response in 15% (3/20), a partial response in 10% (2/20), and no response in 10% (2/20). No recurrence was noticed after follow-up in either of the two groups. Conclusion: Immunotherapy is an option that is easy, safe, cost-effective, and well-tolerated with minimal side effects. Key words: Verruca; Intralesional MMR; Intralesional vitamin D3; Immunotherapy

The Role of Intralesional Vitamin D3 injection in Treatment of Cutaneous Warts

Background: Cutaneous warts are treated primarily with destructive methods such as cryotherapy or electro-cautery. 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 that acts on enhancing cell‑mediated immunity against human papillomavirus for clearance of both treated and distant warts. Aim of the study: To show the efficacy of Intralesional vitamin D3 in treating cutaneous warts. Methods: A total of 50 patients were included in the study. They were injected with vitamin D3 300000 IU (up to 0.5 ml for each wart) at two weeks intervals for maximum of 4 sessions. The clinical response was assessed by photographic measurements at baseline, before each session, and after the completion of treatment and they were followed after 6 months for discovering any recurrence. Results: in this study among 50 patients the response rate to vitamin D3 intralesionally was 94% in general, the mild response was seen in 20(40%) patients and moderate response was seen in 16 (32%) patients while the complete response was 11 (22%) patients. No serious side effects were observed except for pain at the site of injection which most of the patients had. Limitation: small sample size with lack of control group. Conclusions: Intralesional vitamin D shows a good response in the treatment of viral warts.

Role of intralesioal Vitamin D in treatment of cutaneous warts

The majority of treatments for skin warts include destructive techniques like electrocautery and cryotherapy. These techniques of treatment frequently result in recurrence and scarring. Examining the safety and efficiency of intralesional vitamin D3 injection in cutaneous warts is the goal of this study.Total 50 people with recalcitrant warts of different dimensions, frequencies, and longevity participated in the study. 0.2 to 0.5 ml of vitamin D3 (600,000 IU, 15 mg/ml) were injected into the bases of warts. A maximum of 5 warts were administered per session, with sessions occurring every 2 weeks till the warts vanished, or for a total of 3 sessions. Following the final injection, individuals were monitored for six months to look for any recurrence.The trial was completed by 50 patients. Out of 50 patients, 35 (or 70%) showed a complete reaction, five (10%) showed a partial response, and ten (10%) showed no response. In every case, the distant warts completely disappeared.A safe, effective, and affordable therapy option for resistant warts is intralesional vitamin D3.

Efficacy and Safety of Intralesional Vitamin D3 Injection in Recalcitrant Periungual Warts: A Randomized Controlled Trial

Introduction: Although the treatment of recalcitrant warts is often disappointing due to its high recurrence rates, the intralesional injections of Vitamin D3 (as an immunotherapeutic molecule) may regulate epidermal cell proliferation. Objective: To evaluate whether intralesional vitamin D3 immunotherapy is efficient and secure in treating the recalcitrant periungual warts. Materials and Methods: This randomized controlled therapeutic trial was performed in the Department of Dermatology and Venereology of Combined Military Hospital, Dhaka from July 2018 to December 2019. A total of 64 participants’ having different sizes and duration of recalcitrant periungual warts were included. Half of them were injected with about 0.2ml vitamin D3 solution (600,000 IU, 15 mg/ml) at the base of the wart (Group-A) and the remaining participants were subjected to cryotherapy (Group-B). A follow-up period of 6 months following the last session was performed to detect any recurrence. Results: The mean age of participants in Group A and B were 25.9±12.6 and 26.4±12.4 years, respectively (78.1% male in Group-A and 62.5% in Group B). The size and duration of warts between the two groups were not statistically significant (p>0.05). The treatment outcome in Group-A varied from excellent 19(59.4%) to significant 8(25.0%), moderate 3(9.4%), mild (3.1%), and no response 1(3.1%), whereas in Group-B, the results were as follows: excellent 13(40.6%), significant 3(9.4%), moderate 9(28.1%), mild 7(21.9%). The efficacy was significantly higher in Group-A when compared to Group-B (p <0.05). Furthermore, the burning sensation, blister, erythema, hypopigmentation, depigmentation and skin atrophy were significantly higher in Group-B compared to Group-A. The recurrence of warts were 12.5% and 34.4% in Group-A and B respectively. Conclusion: Vitamin D3 injection is more effective and secure than cryotherapy in the treatment of periungual warts. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 3-6

Comparison of Intralesional Vitamin D3 Injection, 5% Koh Cream and Their Combination in Treatment of Cutaneous Warts

Comparison of Intralesional Vitamin D3 Injection, 5% Koh Cream and Their Combination in Treatment of Cutaneous Warts

Efficacy of Intralesional Vitamin D3 Injection in Cutaneous Warts

Background: Cutaneous warts are common dermatological viral infection caused condition which causes cosmetic problems besides it primary morbidity like pain and discomfort. Intralesional vitamin D3 derivatives therapy is recent and effective modality for treatment of cutaneous warts. Objective: To determine the efficacy of intralesional vitamin D3 injection in cutaneous warts in local patients. Methods and patients: A descriptive case series study conducted from June to December 24, 2019 at Dermatology OPD, SMBBMU- Larkana.A sample of 65 patients with cutaneous warts, either gender, age 20-50 years, 3 months to 6 months history were included after taking a valid informed/ written consent. Pregnant and lactating women, patients on immunosuppersive therapy, signs of any systemic or local inflammation or infection, history of pasthma allergic skin disorders meningitis or convulsions, history of hypersensitivity to Vitamin D3 were excluded. The injections of vitamin D3 (vials containing 6,00,000 IU of cholecalciferol in 1 ml = 15 mg)were given at 2 weekly intervals for a maximum of four injections.A standard questionnaire was used to collect demographic and study related data. Data analysis was performed through SPSS Version-21. Descriptive and inferential statistics were calculated. Stratification was done and post stratification chi square test was applied. P-value ≤0.05 was considered as significant. Results: The mean age of patients was 27.9±5.1 with C.I (26.63-29.16) years. The Mean ± SD of duration was 4.4±1.9 with C.I (3.92-4.87) months. The Mean ± SD of number of warts was 14.3±4.2 with C.I (13.25-15.34). Out of 65 patients, 35 (53.8%) were malewhile 25 (38.5%) patients were belong to urban areas. Primary outcome of this study i-e; the efficacy was n=54 (83.1%). Stratified analysis revealed that younger age (20 – 30 years), male gender, urban residence, 3-5 mm size, 2-3 months duration (p value = 0.009) were associated with more efficacy of intralesional vitamin D3 injection in cutaneous warts. Conclusion:This study clearly demonstrates that recalcitrant plantar warts can be treated successfully with intralesional vitamin D3 injection. The immunotherapy of injection vitamin D3 has better patient compliance, good therapeutic response without cosmetic disfigurement and capable of preventing recurrences. Keywords: Efficacy, Intralesional Vitamin D3, Cutaneous Warts, Treatment,Immunotherapy

Intralesional Candida antigen versus intralesional vitamin D3 in the treatment of recalcitrant multiple common warts

There are various therapies available for recalcitrant common warts; however no specific therapy has been established as entirely effective. To assess the efficacy and safety of intralesional Candida antigen injection of vs. intralesional vitamin D3 injection in the treatment of multiple recalcitrant common warts. A total of 80 adult patients with multiple common warts were randomly assigned to one of three groups in this study. Thirty patients were assigned to Group I, who received a 0.3ml intralesional injection of Candida antigen. Thirty patients were assigned to Group II, who received a 0.6-ml (60000IU) intralesional injection of vitamin D3. Twenty patients were in Group-III, who received 0.3ml of normal saline as a control. Each agent was injected at the base of largest wart every 3weeks until full clearance has been obtained, or for a maximum of four sessions. In the Candida antigen, vitamin D3, and saline groups, complete wart clearance was observed in 76.7 percent, 20%, and 0.0 percent, respectively. The side effects were negligible and transient, and there was no recurrence of the lesions. Intralesional injection of Candida antigen is as a safe, simple, cost-effective treatment modality for multiple recalcitrant common warts and it outperforms intralesional vitamin D3.

Does involucrin have a role in verruca vulgaris? A clinical and immunohistochemical study

Introduction:Several modalities are used in the treatment of verrucae vulgaris; however, their side effects are common. Vitamin D3 has been recently used as a treatment in verruca vulgaris.Aim of the Work:We aimed to assess the expression of involucrin in verrucae before and after intralesional injection of vitamin D3 and its correlation with clinical response.Subjects and Methods:This study included 60 patients with verrucae vulgaris. These patients were subjected to intralesional injection of vitamin D3 at 3-week intervals for a maximum of five sessions. The pathological assessment was done by skin biopsies obtained from thirty patients before the first session and after the last session of injection and compared to skin biopsies from 30 healthy individuals.Results:The injected verrucae showed complete response in 39 patients (65%), partial response in 15 patients (25%), and no response in 6 patients (10%). Nonsmoker patients had a better response than smokers. Vitamin D3 injections also resulted in increasing involucrin expression and changing its pattern of expression.Conclusions:Intralesional vitamin D3 is an effective treatment for verrucae vulgaris. Involucrin expression is modified in verrucae.

Comparison of Purified Protein Derivative and Vitamin D in the Treatment of Recalcitrant Warts

Background: Viral warts are caused by human papillomavirus. There are various treatment modalities which cause destruction of the warts. Not all of them are very effective on difficult-to-treat warts. For the treatment of difficult-to-treat warts, new and effective treatment includes intralesional immunotherapy. Objectives: The aim was to evaluate and compare the efficacy of intralesional Vitamin D and tuberculin purified protein derivative (PPD) as immunotherapy in difficult-to-treat warts. Materials and Methods: A total of 100 patients with difficult-to-treat viral warts were enrolled in this randomized controlled study. Group A patients were injected intralesionally with 2.5 TU of tuberculin PPD (0.1 ml) and Group B patients were injected with 0.1 ml of Vitamin D3 per lesion to a maximum of ten lesions. The clinical assessment was done by photographic measurements at baseline, before each treatment session, and after the completion of the treatment every 2 weeks for a total of four sessions. Unpaired t-test was used to compare both the treatment modalities. Results: In Group A, a total of 38 (76%) patients showed complete clearance and 12 (24%) showed partial response, while in Group B, a total of 42 (84%) patients showed complete clearance, while 8 (16%) showed partial response. There was no statistically significant difference between both the modalities. Conclusions: Intralesional Vitamin D3 injection and intralesional PPD may be a treatment option for difficult-to-treat warts that are unresponsive to conventional treatments. Both are equally effective with minimal side effects.

A comparative study of therapeutic efficacy of intralesional measles, mumps, and rubella vaccine and intralesional Vitamin D3 in the treatment of recurrent warts

Background: Recurrent or resistant warts may be due to defective cell-mediated immune response. Immunotherapy is directed at manipulating the immune system to achieve an anti-human papillomavirus immune reaction. Purpose: Our study compared the safety and efficacy of intralesional measles/mumps/rubella (MMR) vaccine to intralesional Vitamin D3 injection in recurrent warts. Methods: Sixty-six patients were divided into two groups of 33 each. In Group A and B, patients were injected with 0.5 ml of Vitamin D3 and 0.5 ml of MMR vaccine, respectively, intralesionally into the base of the largest wart every 2 weeks until complete clearance or for a maximum of 4 doses. The patients were evaluated for clinical improvement and any adverse effects. Results: Complete clearance of warts was noted in 52% (17) in Group A and in 70% (23) in Group B. Excellent to complete response was noted in 82% (27) in Group A and in 91% (30) in Group B. The clinical improvement noted with intralesional MMR vaccine was not statistically different than with intralesional Vitamin D3 (P > 0.05). Conclusion: Intralesional MMR and Vitamin D3 are promising options for recurrent warts.

Intralesional vitamin D in multiple recurrent plantar warts - A single, blind, prospective, placebo-controlled study

INTRODUCTION: Warts or verrucae, caused by the human papillomavirus (HPV), are a benign epidermal proliferation of the skin. Most patients seek medical advice as warts are cosmetically unacceptable and can be painful. Plantar warts, in particular, are typically refractory to treatment requiring multiple treatment sessions. High recurrence rates, pain, and scarring limit the available therapeutic modalities. In contrast, immunotherapeutic approaches stimulate the host immune system by enhancing cellular immunity to eliminate the virus. OBJECTIVE: To assess the safety and efficacy of intralesional vitamin D3 injection to treat multiple recurrent plantar warts. METHODS: 60 patients with multiple recurrent warts were divided into two groups of 30 each. Group 1 received 0.5 ml intralesional vitamin D in the base of the largest wart, and Group 2 received 0.5 ml of normal saline. The sessions were repeated every two weeks for a maximum of four sessions, and patients were followed up for 12 months to detect any recurrences. RESULTS: The study group showed complete clearance in 73.3% (22) individuals, while most controls (70%) showed no response. CONCLUSION: Intralesional vitamin D3 is a safe and effective treatment option for multiple recurrent plantar warts.

Intralesional vitamin D3 versus new topical photodynamic therapy in recalcitrant palmoplanter warts Randomized comparative controlled study.

Recalcitrant palmoplanter warts represent a therapeutic challenge. Side effects of local destructive methods necessitates the need for other less morbid modalities. Recently immunotherapy as well as light based devices and lasers have emerged as therapeutic approaches. To compare between the safety and efficacy of intralesional vitamin D3 injection and photodynamic therapy (PDT) using eosin in treatment of recalcitrant palmoplanter warts. Prospective, randomized, controlled comparative study. Fifty -six patients with recalcitrant palmoplanter warts were randomly divided into 3 groups. Group A was injected with intralesional vitamin D3. Group B was subjected to PDT using eosin loaded in trasferosomes as a photosensitizer. Group C is the control group. Clinical improvement was assessed by photographic records and dermoscopic assessment, at baseline, before each session and after completion of treatment. Patients were followed up for 6 months after cure to detect recurrence. Group A and B showed complete clearance in 88.89 % and 86.36 % respectively compared to 18.75 % in the control group. These results were statistically significant (P value<0.001). No side effects were reported except for pain during injection in group A. In the current study, both vitamin D3 and PDT using Eosin are safe, highly effective and well tolerated modalities in treatment of viral warts.

Immunotherapeutic modalities for the treatment of recalcitrant plantar warts: a comparative study

Background Plantar warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy has been used as a promising alternative therapeutic option in such recalcitrant cases. Aim To evaluate and compare the efficacy and safety of the intralesional injection of vitamin D3, zinc sulfate 2%, and Candida antigen in the treatment of recalcitrant plantar warts. Patients and methods The study included 152 adult patients with single or multiple recalcitrant plantar warts. They were equally subdivided into four groups (38 patients in each): 2% zinc sulfate, vitamin D3, Candida antigen, and normal saline respectively. Injections were done at 3-week intervals until complete resolution or for a maximum of 4 sessions. Results Complete response was achieved in 20 patients (52.7%) of the zinc sulfate group, 34 patients (89.5%) of the intralesional vitamin D3 group, 25 patients (65.7%) of the intralesional Candida antigen group and 8 patients (21.2%) of the saline group. The difference between the groups was statistically significant in favor of vitamin D3 (p = .037). Conclusions Recalcitrant plantar warts were best treated with vitamin D3 that also has the advantages of better response on distant warts, minimal side effects, and low rate of wart recurrence.

Immunohistochemical Expression of Involucrin in Verruca Vulgaris before and after Intralesional Injection of Vitamin D3

Immunohistochemical Expression of Involucrin in Verruca Vulgaris before and after Intralesional Injection of Vitamin D3

Intralesional injection of vitamin D in verruca vulgaris increases cathelicidin (LL37) expression; therapeutic and immunohistochemical study

Introduction Despite the promising results of intralesional vitamin D in verruca treatment; its precise mechanism of action is not fully understood. Aim of the work To investigate immunohistochemical expression of cathelicidin (LL 37) before and after injection of vitamin D in verruca vulgaris and to clarify its possible role in pathogenesis of verruca. Patients and methods This study included 20 patients with multiple verrucae vulgaris. Vitamin D was intralesionally injected every 2 weeks for a maximum of 4 sessions or clearance of verrucae. Skin biopsies were taken from the patients before and at the end of the study and compared to skin samples from ten apparently healthy, age and sex matched individuals for histopathological and immunohistochemical assessment of LL37 expression. Results Eight (40%) verrucae showed complete response, seven (35%) showed partial response and five (25%) showed no response. Decreased epidermal thickness and reduced density of inflammatory cells in dermis were observed after injection. Significant increase in LL37 intensity of expression was observed after intralesional injection of vitamin D3 (p = .003) and in verrucae showing complete clinical response (p = .022). Conclusions Intralesional injection of vitamin D is effective and safe treatment for verruca vulgaris and causes increase in LL37 expression.