DISCUSSION
wart, itching, swelling, wart lesion, palmoplantar warts, Marjunath
PLANTAR WARTS, WART, RECURRENCE, HPV INFECTION, ADVERSE EVENTS, COMMON WARTS, PERIUNGUAL WARTS, MINOR, WARTS, FILIFORM WARTS
To put it simply, warts are a harmless, widespread, and frequently recurring HPV infection of the skin and mucous membranes.This research found that administering vitamin D3 intralesional was an effective method for treating cutaneous warts. Forty Iraqi patients (14 males and 26 females) with a total of 204 cutaneous warts were treated by injecting 0.2 mL of vitamin D3 (600 000 IU; 15 mg/mL) gently in the base of each wart lesion, with a cap of 5 lesions each session. Up to four treatments, each spaced 2 weeks apart, may be necessary to completely remove the warts. After 2 months, 167 warts (81.9%) were completely gone, 23 warts (11.3%) had a partial reaction, and 14 warts (6.7%) had not responded at all. It is unknown how vitamin D actually works to get rid of warts. Vitamin D derivatives are thought to be effective against warts because of their potential to control the growth and differentiation of epidermal cells and the secretion of cytokines. The VDR and vitamin D‐1‐hydroxylase gene expression was discovered to be elevated upon toll‐like receptor activation of the macrophages of the human, leading to the promotion of antimicrobial peptide production.Mild swelling and itching at the injection site were the only adverse events seen in our trial, and both resolved on their own within a few days. Clearance of the injected warts was accompanied by removal of warts at unrelated anatomical sites, suggesting that the immune response is systemic rather than localized to the injection site. All but one patient who initially showed only a partial response to the treatment eventually saw their warts completely disappear over the course of the 6‐month follow‐up period. As for warts, they did not come back during the follow‐up.Vitamin D3 administered intralesional has been studied extensively for its potential to effectively treat warts. Twenty patients with multiple or single plantar warts participated in the study by AKtas et al. Patients averaged two sessions of treatment every 4 weeks. Of the total number of patients, 16 (80%) showed complete response, 1 (10%) showed partial reaction, and 3 (0%) showed no response at all.Moscarelli et al. successfully cured a refractory wart in a 41‐year‐old patient with a history of renal transplantation with calcitriol solution.Of the 60 patients enrolled in the study by Naresh et al., 60% had palmoplantar warts, 20% had common warts, 10% had periungual warts, and 10% had filiform warts, repeating the same regimen every 3 weeks with the same dosage and technique. Forty‐eight of the patients (80%) demonstrated a full recovery, whereas six patients (10%) had a moderate reaction, and six patients (10%) had a minor one. During a median follow‐up of 6 months, warts returned in four patients (6.66%).A total of 42 individuals with numerous warts participated in the Kavya research by Marjunath et al. In a study where patients only had two warts injected at a time, 78.57% saw complete clearance, 14.2% exhibited a moderate response, and 7.1% saw a mild response. Recurrence of palmoplantar warts occurred in only one patient.The effectiveness of intralesional zinc sulfate 2% solution versus vitamin D3 in the treatment of plantar warts was examined in a study by El Sayed et al. A total of 105 participants participated in the study, with 35 individuals representing each of the three categories. Intralesional injection of 2% zinc sulfate solution was used in the first group, vitamin D3 was injected into the second, and intralesional injection of normal saline was utilized in the third. At most, each patient received four treatments at 2‐week intervals. Complete response was higher in the zinc group (71.4%), compared to the vitamin D3 group (62.9%), and the normal saline group (40%) at the end of the research. Intralesional injection of 2% zinc sulfate was found to be more efficacious than intralesional injection of vitamin D3 in this investigation.Each of the 62 participants in the study by El Taieb et al. had at least three common warts, of which some received intralesional PPD injections, others received vitamin D3 injections, and the rest served as controls. Treatment sessions occurred every other week for a maximum of four sessions. The results showed that among those who were treated with PPD, 43 patients (69.4%) saw complete clearance, whereas among those who were given vitamin D3, 22 patients (35.5%) saw complete response, and 21 patients (33.9%) saw partial response. Each set of findings was statistically significant when compared to the control group. PPD showed statistically significant superiority over vitamin D3 in the common warts treatment.