title: Intralesional Vitamin D3Injection in the Treatment of Recalcitrant Warts: A Novel Proposition.
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 D3to exploit its reported action as an immunotherapeutic molecule in addition to its topical effects. To our knowledge, there are no reports of intralesional vitamin D3injections 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 D3solution (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 D3is a safe, effective, and an inexpensive treatment option for recalcitrant warts.
authors.affiliation: 1 Department of Dermatology, Hassan Institute of Medical Sciences, Hassan, Karnataka state, India.
authors.forename: Sonia
authors.initials: S
authors.lastname: Raghukumar
authors.affiliation: 1 Department of Dermatology, Hassan Institute of Medical Sciences, Hassan, Karnataka state, India.
authors.forename: B C
authors.initials: BC
authors.lastname: Ravikumar
authors.affiliation: 1 Department of Dermatology, Hassan Institute of Medical Sciences, Hassan, Karnataka state, India.
authors.forename: K N
authors.initials: KN
authors.lastname: Vinay
authors.affiliation: 1 Department of Dermatology, Hassan Institute of Medical Sciences, Hassan, Karnataka state, India.
authors.forename: M R
authors.initials: MR
authors.lastname: Suresh
authors.affiliation: 1 Department of Dermatology, Hassan Institute of Medical Sciences, Hassan, Karnataka state, India.
authors.forename: Archit
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: 1 Department of Dermatology, Hassan Institute of Medical Sciences, Hassan, Karnataka state, India.
authors.forename: D P
authors.initials: DP
authors.lastname: Yashovardhana
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002762:Cholecalciferol / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D015552:Injections, Intralesional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014860:Warts / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D002762:Cholecalciferol
keywords: immunotherapy; intralesional; recalcitrant warts; vitamin D3