A randomised double blind active controlled study for comparison of intralesional MMR versus intralesional Vitamin D3 in the management of cutaneous warts
Citation Information :
Jain J, Maheshwari K, Saluja A, Vyas K, Gupta K. A randomised double blind active controlled study for comparison of intralesional MMR versus intralesional Vitamin D3 in the management of cutaneous warts. 2022; 1 (1):24-30.
Background: Immunotherapy has recently emerged as an option to deal with warts while avoiding major drawbacks of destructive modalities as well as preventing recurrence.
Objectives: To compare the efficacy of intralesional injection of Vitamin D3 and MMR vaccine in terms of remission and recurrence and their various side effects in the management of cutaneous warts.
Material and Methods: A total of 60 patients were divided in groups of two. Group A received intralesional MMR vaccine into largest wart, and group B received intralesional vitamin D3 into each lesion with maximum of five warts treated in one session. This was repeated every 3 weeks until complete clearance of all the warts or for a maximum of 3 treatment sessions in both the groups. 6 months follow up was done for any signs of recurrence.
Results: In group A (MMR group) 80% patients showed complete response, 10% showed partial response, 3.3% showed poor response and 6.7 % patients showed no response at all whereas in group B (Vitamin D3), complete response was seen in 70% patients, partial response in 16.7%, poor response in 6.7% and no response in 6.7% patients. There was no significant difference between the two groups regarding the response rate. Only 2 patients in group A and 5 patients in group B showed recurrence of warts groups after 6 month-follow up period.
Conclusions: Both the modalities i.e. intralesional injection MMR and vitamin D3 are effective with good cure rates, excellent safety profile and are cost-effective. They can be considered as first line therapy in management of all cutaneous warts.
Singh SK, Mohan A, Gupta AK, Pandey AK. A comparative study between intralesional PPD and vitamin D3 in treatment of viral warts; Int J Res Dermatol. 2018;4(2):197-201.
Naseem R, Aamir S. The Efficacy of Intralesional Measles, Mumps, Rubella (MMR) Antigen in Treatment of common Warts; PJMS 2013; 7(4):1130-1133.
Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ. 2002;325:461.
Alghamdi KM, Khurram H. Successful treatment of plantar warts with very diluted bleomycin using a translesionalmultipuncture technique: pilot prospective study. J Cutan Med Surg. 2012; 16:250-6.
Kimura U, Takeuchi K, Kinoshita A, Takamori K. Suga Y. Long-pulsed 1064-nm neodymium: yttriumaluminum-gamet laser treatment for refractory warts on hands and feet. J Dermatol. 2014;41:252-7.
El-Mohamady Ael-S, Mearag I, El-Khalawany M, Elshahed A, Shokeir H, Mahmoud A. Pulsed dye laser versus Nd:YAG laser in the treatment of plantar warts: a comparative study. Lasers Med Sci. 2014;29: 1111-6.
Cockayne S, Curran M, Denby G. Ever T: cryotherapy versus salicylic acid for the treatment of verrucae-a randomised controlled trial. Health Technol Assess. 2011;15:1-170.
Bruggink SC, Gussekloo J, Berger MY. Cryotherapy with liquid nitrogen versus topicalsalicylic acid application for cutaneous warts in primary care: randomized controlled trial. CMAJ. 2010; 182:1624-30.
Kavya M, Shashikumar BM, Harish MR, Shweta BP. Safety and Efficacy of Intralesional Vitamin D3 in Cutaneous Warts: An Open Uncontrolled Trial. J Cutan Aesthet Surg. 2017;10(2):90-4.
Shaldoum DR, Hassan GFR, El Maadawy EH, ElMaghraby GM. Comparative clinical study of the efficacy of intralesional MMR vaccine vs intralesional vitamin D injection in treatment of warts. J Cosmet Dermatol. 2020; 19(8):2033-40.
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;37:853-9.
Kus S, Ergun T, Gun D, Akin 0. Intralesional tuberculin for treatment of refractory warts. J Eur Acad Dermatol Venereol. 2005; 19(4):515-6.
Nofal A, Nofal E, Yosef A, Nofal H. Treatment of recalcitrant warts with intralesional measles, mumps, and rubella vaccine: a promising approach. Int J Dermatol. 2015;54(6):667-71.
Raghukumar S, Ravikumar BC, Vinay KN, Suresh MR, Aggarwal A, Yashovardhana DP. Intralesional Vitamin D3 Injection in the Treatment of Recalcitrant Warts: A Novel Proposition. J Cut Med Surg. 2017;21(4):320-4.
Kareem IMA, Ibrahim IM, Mohammed SFF, Ahmed AA. Effectiveness of intralesional vitamin D3 injection in the treatment of common warts: Singleblinded placebo-controlled study. Dermatol Ther. 2019 May;32(3):e12882.
Egawa K, Ono T. Topical vitamin D3 derivatives for recalcitrant warts in three immuno-compromised patients. Br J Dermatol. 2004;150:374-76.
Moscarelli L, Annunziata F, Mjeshtri A, Paudice N, Tsalouchos A, Zanazzi M, Bertoni. Successful treatment of refractory wart witha topical activated vitamin D in a renal transplant recipient. Case Rep Transplant. 2011; 2011:368623.
Akula M L, Shetty M, Shetty V, Patel P, Basil A. Comparative study of therapeutic efficacy of intralesional vitamin D3 versus intralesional purified protein derivative in the treatment of warts. IP Indian J Clin Exp Dermatol 2018; 4(3):226-31.
Singh SK, Mohan A, Gupta AK, Pandey AK. A comparative study between intralesional PPD and vitamin D3 in treatment of viral warts. Int J Res Dermatol. 2018;4:197-201.