Common warts (verruca vulgaris) are caused by human papilloma virus (HPV), a double-stranded DNA. They are one of the most common problems encountered in dermatology and may present a difficult treatment dilemma as no particular therapy has demonstrated complete efficacy. Treatment options include cryotherapy, surgical excision, bleomycin and various lasers. Each mode of therapy has its own complications and failure rates.
Previously mentioned methods are not always successful and may be associated with severe adverse events. Even when existing verrucae are successfully eradicated, patients may develop new warts in other areas.
Intralesional vitamin D has been utilized for the treatment of warts as it controls cell proliferation and differentiation and has immunoregulatory activities. Its effects are mediated via the vitamin D receptor (VDR), which is present in keratinocytes, melanocytes, fibroblasts, and immune system cells of the skin.
LL-37 is a gene encoding for the only member of the human cathelicidin family which serve a critical role in mammalian innate immune defense against invasive viral infection.
Vitamin D up-regulates genetic expression of cathelicidin, which exhibits broad-spectrum microbicidal activity against bacteria, fungi, and viruses.
The aim of this work was to evaluate the safety and efficacy of intralesional Vitamin D3 for the treatment of verruca vulgaris, detect histopathological changes in verruca vulgaris after injection of vitamin
Summary and conclusions
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D3 and compare between immunohistochemical expression of LL 37 before and after the injection.
This study was performed on 20 patients with multiple verruca vulgaris injected with vitamin D3 and ten apparent healthy individuals as control group.
As regards the clinical response of the injected wart, our results showed relatively good cure rate, 40% and 20% of the treated patients showed complete response in the 1st and the 2nd injected warts, respectively. Partial response in 35% and 55% of the 1st and the 2nd injected warts, respectively. As regards the response of the non-injected wart, 66.7% showed partial response.
No serious side effects were reported in patients included in this study with injection of vitamin D3. Pain was the main side effect but also vasovagal attack during injection was reported.
There was a negative relation between smoking and clinical response in this study.
The histopathological changes in warts after injection of vitamin D3 were decreasing in the thickness of epidermis and reduction in inflammatory cells in dermis.
There was no LL37 expression in normal or non-inflamed skin (control group) but LL-37 was expressed by keratinocytes in verruca vulgaris.
In this study, LL37 expression was higher after injection of vitamin D3 than before the injection of D3. |
