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Aryanian Z, Balighi K, Goodarzi A, Afshar ZM, Hatami P. Vitamin D and HPV infection: Clinical pearls. J Cosmet Dermatol 2024; 23:2509-2512. [PMID: 38491753 DOI: 10.1111/jocd.16280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/11/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Zeinab Aryanian
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Babol University of Medical Sciences, Babol, Iran
- Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Dermatology, School of Medicine Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Mullen SA, Myers EL, Brenner RL, Nguyen KT, Harper TA, Welsh D, Keffer S, Mueller J, Whitley MJ. Systematic Review of Intralesional Therapies for Cutaneous Warts. JID INNOVATIONS 2024; 4:100264. [PMID: 38585192 PMCID: PMC10990969 DOI: 10.1016/j.xjidi.2024.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/12/2023] [Accepted: 01/05/2024] [Indexed: 04/09/2024] Open
Abstract
Intralesional therapies are used for recalcitrant warts, but no Food and Drug Administration-approved treatment exists nor is there consensus regarding the most efficacious therapy. Therefore, this systematic review aims to summarize efficacy and adverse events reported in 62 randomized controlled trials (RCTs) of intralesional therapies for cutaneous warts. The most studied intralesional therapies included measles, mumps, rubella (MMR) vaccine (n = 24 studies), purified protein derivative (PPD) (n = 19 studies), vitamin D3 (n = 15 studies), and Candida antigen (n = 14 studies). Most studies included adult and pediatric patients or adults alone, with only 4 studies on pediatric patients alone. MMR vaccine was the most studied treatment (n = 853 patients). MMR had a complete response rate of 27-90%. The next most common treatment, PPD, had a complete response rate of 45-87%. Other treatments included Candida antigen and vitamin D3, with complete response rates of 25-84% and 40-96%, respectively. The most frequent side effects were injection-site reactions and flu-like symptoms. This systematic review represents a useful summary of intralesional therapy RCTs for clinician reference. This study also highlights the lack of large multi-institutional RCTs, despite many patients being treated for this widespread problem.
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Affiliation(s)
- Sarah A. Mullen
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emma L. Myers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rebecca L. Brenner
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kim T. Nguyen
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tara A. Harper
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Darby Welsh
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Storm Keffer
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jenna Mueller
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Melodi Javid Whitley
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
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Pazyar N, Sananzadeh S, Yaghoobi R, Bakhtiari N. Comparison of Intralesional Vitamin D with Intralesional Triamcinolone Acetonide in the Treatment of Keloids. World J Plast Surg 2024; 13:44-52. [PMID: 39193238 PMCID: PMC11346683 DOI: 10.61186/wjps.13.2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 07/19/2024] [Indexed: 08/29/2024] Open
Abstract
Background Hypertrophic scars and keloids are disorders caused by the excessive growth of connective tissue, associated with the accumulation of collagen and cellular matrix components. These scars are caused by abnormal wound healing and can have a great impact on patients' lives. Therefore, we aimed to compare the effect of intralesional injection of vitamin D with triamcinolone acetonide in the treatment of keloid. Methods This study was a one-sided blind clinical trial, conducted on 22 patients (44 samples) with keloid. It was a randomized, blinded clinical trial, conducted in Imam Khomeini Hospital in Ahvaz, Iran in 2022. In each group, triamcinolone or vitamin D was injected at the lesion site with an interval of three weeks and an average of 6 sessions. The patients were re-evaluated 3 months after the end of the treatment in terms of recurrence. Results By examining the VSS scale in each of the groups, this scale decreased significantly in both groups after the intervention (P=0.001), which was greater in the group receiving triamcinolone (P=0.001). Conclusion It seems that the injection of vitamin D at the site of the lesion helps to treat it, but the effectiveness of the usual triamcinolone treatment was still higher, it is suggested to use vitamin D as an adjunctive treatment in these patients.
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Affiliation(s)
- Nader Pazyar
- Dermatology Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sedigheh Sananzadeh
- Dermatology Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Yaghoobi
- Dermatology Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nima Bakhtiari
- Pharmacology Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Al‐Sabak H, Al‐Hattab M, Al‐Rammahi M, Al‐Dhalimi M. The efficacy of intralesional vitamin D3 injection in the treatment of cutaneous warts: A clinical therapeutic trial study. Skin Res Technol 2023; 29:e13442. [PMID: 37632174 PMCID: PMC10432866 DOI: 10.1111/srt.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The human papillomavirus that causes warts is usually harmless, and it can infect any part of the skin or mucous membranes. Despite the availability of several treatments, warts often return, and scarring, pigmentation changes, and recurrence are all possible side effects. AIM Intralesional vitamin D3 was employed as an immunotherapy for cutaneous warts in the current investigation. MATERIALS AND METHODS In Al-Sadr Medical City in the city of Al-Najaf Al-Ashraf, a skin clinic conducted a therapeutic clinical experiment. A total of 204 cutaneous warts were examined in 40 patients (14 men and 26 females). Vitamin D3 solution of the dose (600 000 IU) was injected into the lesions' bases, with 0.2 mL per patient. Each session could only inject up to five warts. The injections were given every 2 weeks for a total of four times. Instructing patients to forego the use of any topical or oral medication was also a part of the protocol. Each patient was evaluated for recurrence risk before each therapy and then again 6 months later. RESULT AND DISCUSSION There was a wide range of patient ages in this study, from 20 months to 52 years. About 65% of the cases included females. When looking at the many kinds of warts, the most prevalent was the common wart (71.6%). After four treatments, a positive response was considered to have occurred when all lesions had disappeared, a partial response when more than half of the lesions had disappeared, and no reaction when less than half of the lesions had disappeared. The final tally was 81.9% for those who responded in whole, 11.3% for those who responded partially, and 6.9% for those who did not respond at all. Next-session complete response rates were 12.7%, 29.9%, 54.9%, and 81.9%, respectively. Thirteen people experienced adverse symptoms, most noticeably minor swelling and itching. Within 6 months of follow-up, warts had completely disappeared for all patients with a partial or modest response except one who had no reaction. CONCLUSION Vitamin D3 administered intralesional is an effective and low-cost treatment for cutaneous warts.
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Affiliation(s)
- Haider Al‐Sabak
- Head of Dermatology and Laser Department, College of MedicineUniversity of KufaNajafIraq
| | - Mohammed Al‐Hattab
- Department of DermatologyUniversity of Babylon College of MedicineBabylonIraq
| | | | - Muhsin Al‐Dhalimi
- Dermatology and Laser Department, College of MedicineUniversity of KufaNajafIraq
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Mohta A, Kushwaha RK, Agrawal A, Sharma MK, Gautam U, Jain SK. Evaluation of the Efficacy of Intralesional Measles, Mumps, and Rubella Vaccine with Intralesional Vitamin D3 as Immunotherapies in the Treatment of Recalcitrant Cutaneous Warts in Adult- A Randomized Placebo-Controlled Study. Indian Dermatol Online J 2021; 12:879-887. [PMID: 34934726 PMCID: PMC8653728 DOI: 10.4103/idoj.idoj_573_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction: Currently, various destructive and ablative treatment options are conventionally used for warts, but all of them are limited in some form by their adverse effects, high recurrences, suboptimal effectiveness, and the need to treat every wart. Lately, immunotherapy has emerged as a safe treatment relying on biological substances that modulate the immune system to achieve disease control. Aims and Objectives: We aimed at conducting a placebo-controlled study to compare the rate of efficacy of intralesional MMR vaccine with vitamin D3 in the management of recalcitrant extragenital warts in immune-competent adults. Follow-up was done at third and sixth month. Materials and Methods: Patients were divided into three groups, namely, group A, B, and C. Groups A, B, and C received intralesional MMR vaccine, vitamin D3 and normal saline, respectively, in the largest wart. The injections were repeated every 2 weeks, for a maximum of four injections. Results: Among injected warts, in group A, complete clearance was seen in 29 (87.8%) patients, partial clearance in two (6.1%) and no response in two (6.1%) patients. In group B, 24 (77.4%) patients, five (16.1%) patients, and two (6.5%) patients showed signs of complete, partial, and no clearance, respectively, in injected warts. Complete response in distant warts was seen in 25 (75.7%) patients in group A and 20 (64.5%) patients in group B. There was no statistically significant difference between responses of the two groups. In group C, only three (12.5%) patients had complete clearance in injected warts, and none in distant warts. Recurrence was seen in two (6.4%) patients, each in group B and C. However, for management of verruca plana MMR was found to be superior to vitamin D3. Limitations: Our study was limited by a small sample size, absence of immunological analysis, and limited follow-up period. Conclusion: MMR vaccine and vitamin D3 are equally effective and safe treatment option for multiple, recalcitrant warts, as well as warts on difficult to treat sites with minimal recurrence.
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Affiliation(s)
- Alpana Mohta
- Department of Dermatology, Venereology and Leprology, Sardar Patel Medical College, Kota, Rajasthan, India
| | - Ramesh K Kushwaha
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Aditi Agrawal
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Manoj K Sharma
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Umesh Gautam
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Suresh K Jain
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
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Mohammed YF, Ibrahim HS, Elbarbary MA, Elsaie ML. Comparative study of intralesional tuberculin protein purified derivative (PPD) and intralesional measles, mumps, rubella (MMR) vaccine for multiple resistant warts. J Cosmet Dermatol 2020; 20:868-874. [PMID: 33118675 DOI: 10.1111/jocd.13634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cutaneous warts are frequent conditions that possess much challenge to treat. OBJECTIVE To evaluate safety and efficacy of intralesional injection of tuberculin purified protein derivative (PPD) antigen injection vs MMR (mumps, measles, rubella) antigen for the treatment of multiple warts. METHODS The study included 90 Patients who were divided into three groups (A, B, and C). Each group consisted of (30) patients. Group (A) subjects received intralesional PPD injections. Group (B) subjects received intralesional MMR antigen injection and Group (C) received intralesional saline injection. RESULTS Full clearance of warts was observed in 18 (60%) of patients in group (A) (70%) vs 24 patients (80%) in group (B). Distal warts completely disappeared in 18 (60%) of patients in group A and 12 (40%) of patients in group B. Infrequent side effects including pain, erythema, and minimal induration were reported in both groups. CONCLUSION We established a good safety and efficacy profile for tuberculin PPD and MMR antigens in resistant wart treatment.
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Affiliation(s)
| | - Hany S Ibrahim
- Department of Dermatology, Al Azhar University, Cairo, Egypt
| | | | - Mohamed L Elsaie
- Department of Dermatology, National Research Centre, Giza, Egypt
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Mohta A, Kushwaha RK, Gautam U, Sharma P, Nyati A, Jain SK. 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. Pediatr Dermatol 2020; 37:853-859. [PMID: 32681688 DOI: 10.1111/pde.14280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Alpana Mohta
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
| | | | - Umesh Gautam
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
| | - Pritee Sharma
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
| | - Asha Nyati
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
| | - Suresh Kumar Jain
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
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