Serum vitamin D level in patients with viral warts:

Relationship between human papillomavirus and serum vitamin D levels: a systematic review

BACKGROUND

Human papillomavirus (HPV) is one of the most prevalent sexually transmitted diseases worldwide. The present review was conducted to accumulate evidence on the relationship between cervicovaginal human papillomavirus infection and serum vitamin D status.

METHODS

Electronic databases including Web of Science, Embase, Scopus, and PubMed were searched by different combinations of keywords related to "human papillomavirus" and "vitamin D", obtained from Mesh and Emtree with AND, and OR operators without any time restriction until December 24, 2022. Selection of articles was based on the inclusion and exclusion criteria. Newcastle-Ottawa Scale was used for quality assessment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was applied for reporting.

RESULTS

In total, 276 citations were retrieved. After removing duplicates, and non-related articles, the full texts of 7 articles were reviewed including 11168 participants. Three studies reported that there was a positive relationship between vitamin D deficiency and cervicovaginal human papillomavirus while three studies did not. One study showed a significant positive association between higher vitamin D stores and short-term high-risk human papillomavirus persistence.

CONCLUSIONS

The findings showed no firm evidence for any association between serum vitamin D level and cervicovaginal human papillomavirus infection, although the possible association could not be discarded. Further investigations are needed to reach sound evidence.

How far is vitamin D implicated in cutaneous infections

Vitamin D is an important cornerstone in the immunologic cascade of many skin infections, systemic infections with cutaneous presentations, and other infectious dermatologic diseases where infections could be a culprit. Vitamin D supplementation is proposed as a protective measure against their occurrence and exacerbation, especially with the emergence of several viral pandemics in recent years. Vitamin D plays a key role in the maintenance of a balanced immunologic profile which could be reflected by a lowered incidence and morbidity of infections. Vitamin D screening and supplementation in patients with deficiencies or insufficiencies should be a part of the dermatologic approach to patients with these diseases.

Diagnostic and therapeutic implications of vitamin D deficiency in patients with warts: A case-controlled study

BACKGROUND

Cutaneous warts are frequent conditions that possess much challenge to treat.

OBJECTIVE

To verify the potential role of vitamin D in the pathogenesis of viral warts by measuring the serum levels of vitamin D in patients diagnosed with viral warts compared to healthy controls and to verify whether oral vitamin D supplementation of those vitamin D-deficient patients would result in wart clearance.

METHODS

To evaluate the serum vitamin D levels, the study recruited 80 subjects, including 40 patients diagnosed with viral warts and 40 age- and sex-matched healthy controls. All patients were subjected to detailed history taking and examination to detect duration and type of warts. Serum vitamin D levels were measured using ELISA.

RESULTS

Thirty-five percent of patients had sufficient vitamin D levels (54-90 nmol/L), and 40% of patients had insufficient levels (50-80 nmol/L), while 25% of them had deficient levels (<50 nmol/L). In healthy group, 30% had sufficient levels, and 45% had insufficient levels, while 25% had deficient levels. There was an insignificantly lower serum level of vitamin D as well as an insignificantly deficient vitamin D status among patients compared to healthy controls.

CONCLUSION

Vitamin D serum levels appear to be lower among viral wart patients, and oral supplementation studies need to be more intensely investigated before elucidating its role; if any, in wart clearance.

A comparative study of the efficacy and safety of intralesional measles, mumps, and rubella vaccine versus intralesional vitamin D3 for the treatment of warts in children

BACKGROUND

Intralesional vitamin D3 has recently emerged as a new treatment for cutaneous warts. The use of the measles, mumps, and rubella (MMR) vaccine for this purpose is an established modality. However, relevant data on the efficacy of either the MMR vaccine or vitamin D3 as immunotherapy for cutaneous warts in the pediatric population are limited.

OBJECTIVES

To compare the efficacy and safety of intralesional injections of MMR vaccine to intralesional injections of vitamin D3 in children aged 8-16 years with multiple warts.

METHODS

A total of 74 children were randomly allocated into two groups. Group A patients received intralesional MMR vaccine into the largest wart, and group B received intralesional vitamin D3 into the largest wart. The injections were repeated every 4 weeks until clearance or for a maximum of three treatments. After the last injection, children were followed up every 2 weeks for 3 months, and at the sixth month, a final clinical assessment was conducted.

RESULTS

Of 74 children, 60 completed the study, with 30 children in each group. Complete clearance of the injected wart was observed in 26 (86.67%) patients in the MMR group (group A) and 23 (76.7%) patients in the vitamin D3 group (group B). Distant warts cleared in 23 (76.7%) patients in group A compared to 20 (66.6%) patients in group B. There was no significant difference between groups. No recurrence was seen in group A, whereas two (6.6%) children in group B exhibited recurrence in the ensuing 6-month follow-up. The most common adverse events were injection site pain and swelling.

CONCLUSION

Both intralesional MMR and vitamin D3 are safe, generally well-tolerated, and equally effective in children for the treatment of cutaneous warts.