A comparative study between intralesional PPD and vitamin D3 in treatment of viral warts

Santosh Kumar Singh, Aayushi Mohan, Anil Kumar Gupta, Amit Kumar Pandey


Background: Viral warts are caused by human papillomavirus. There are innumerable treatment modalities but they may result in partial clearance or recurrence. Some newer and effective treatments include intralesional immunotherapy. We undertook a study to evaluate the safety and efficacy of two such immunotherapy namely tuberculin purified protein derivative (PPD) versus intralesional vitamin D3 for the treatment of viral warts.

Methods: A total of 80 patients were included in the study. Group 1 patient were injected with 10 TU of tuberculin PPD (0.1 ml) intralesional while in group 2 patients were injected (0.5 ml) vitamin D3. The clinical assessment was done by photographic measurements at baseline, before each treatment session, and after the completion of treatment.

Results: In group 1 A total of 80% (32 patients) showed complete clearance and 20% (8 patients) showed partial response while in group 2 72.5% (29 patients) showed complete clearance while 27.5% (11 patients) showed partial response. No significant side effects were observed except for pain at the site of injection.

Conclusions: Intralesional vitamin D and intralesional Tuberculin PPD immunotherapy shows significant results in treatment of viral warts.


Viral wart, Immunotherapy, Tuberculin purified protein derivative, Vitamin D3

Full Text:



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 translesional multipuncture 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:yttrium-aluminum-garnet 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. EVerT: 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 topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial. CMAJ. 2010;182:1624-30.

Majewski S, Jablonska S. Immunology of HPV infection and HPV-associated tumors. Int J Dermatol. 1998;37:81-95.

Majid I, Imran S. Immunotherapy with intralesional Candida albicans antigen in resistant or recurrent warts: A study. Indian J Dermatol. 2013;58:360-5.

Kim KH, Horn TD, Pharis J, Kincannon J, Jones R, O'Bryan K, et al. Phase 1 clinical trial of intralesional injection of Candida antigen for the treatment of warts. Arch Dermatol. 2010;146:1431-3.

Johnson SM, Roberson PK, Horn TD. Intralesional injection of mumps or Candida skin test antigens: A novel immunotherapy for warts. Arch Dermatol. 2001;137:451-5.

Nofal A, Nofal E. Intralesional immunotherapy of common warts: Successful treatment with mumps, measles and rubella vaccine. J Eur Acad Dermatol Venereol. 2010;24:1166-70.

Meena JK, Malhotra AK, Mathur DK, Mathur DC. Intralesional immunotherapy with Mycobacterium w vaccine in patients with multiple cutaneous warts: Uncontrolled open study. JAMA Dermatol. 2013;149:237-9.

Shaheen MA, Salem SA, Fouad DA, Abd El-Fatah AA. Intralesional tuberculin (PPD) versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: a comparative clinical and immunological study. Dermatol Ther. 2015;28(4):194-200.

Lee JY, Kim CW, Kim SS. Preliminary study of intralesional bleomycin injection for the treatment of genital warts. Ann Dermatol. 2015;27:239-41.

Garg S, Baveja S. Intralesional immunotherapy for difficult to treat warts with Mycobacterium w vaccine. J Cutan Aesthet Surg. 2014;7:203-8.

Gundeti MS, Reddy RG, Muralidhar JV. Subcutaneous intralesional Ksharodaka injection: a novel treatment for the management of warts: a case series. J Ayurveda Integr Med. 2014;5:236-40.

Majid I, Imran S. Immunotherapy with intralesional Candida albicans antigen in resistant or recurrent warts: a study. Indian J Dermatol. 2013;58:360-5.

Singh S, Chouhan K, Gupta S. Intralesional immunotherapy with killed Mycobacterium indicus pranii vaccine for the treatment of extensive cutaneous warts. Indian J Dermatol Venereol Leprol. 2014;80:509-14.

Gupta S, Malhotra AK, Verma KK, Sharma VK. Intralesional immunotherapy with killed Mycobacterium w vaccine for the treatment of ano-genital warts: An open label pilot study. J Eur Acad Dermatol Venereol 2008;22:1089-93.

Horn TD, Johnson SM, Helm RM, Roberson PK. Intralesional immunotherapy of warts with mumps, Candida, and Trichophyton skin test antigens: A single-blinded, randomized, and controlled trial. Arch Dermatol. 2005;141:589-94.

Moscarelli L, Annunziata F, Mjeshtri A. Successful treatment of refractory wart with a topical activated vitamin D in a renal transplant recipient. Case Rep Transplant. 2011;2011:368623.

Rind T, Oiso N, Kawada A. Successful treatment of anogenital wart with a topical vitamin D(3) derivative in an infant. Case Rep Dermatol. 2010;2:46-49.

AlGhamdi K, Kumar A, Moussa N. The role of vitamin D in melanogenesis with an emphasis on vitiligo. Indian J Dermatol Venereol Leprol. 2013;79:750-8.

Imagawa I, Suzuki H. Successful treatment of refractory warts with topical vitamin D3 derivative (maxacalcitol, 1alpha, 25-dihydroxy-22-oxacalcitriol) in 17 patients. J Dermatol. 2007;34:264-6.

Elela IM, Elshahid AR, Mosbeh AS. Intradermal vs intralesional purified protein derivatives in treatment of warts. Gulf J Deramatol Venereol. 2011;18:21-6.

Kus S, Ergun T, Gun D, Akin O. Intralesional tuberculin for treatment of refractory warts. J Eur Acad Dermatol Venereol. 2005;19:515-6.

Wananukul S, Chatproedprai S, Kittiratsacha P. Intralesional immunotherapy using tuberculin PPD in the treatment of palmoplantar and periungual warts. Asian Biomed. 2010;3:739-43.

Raghukumar S, Ravikumar BC, Vinay KN, Suresh MR, Aggarwal A,Yashovardhan DP, Intralesional Vitamin D3 injection in treatment of recalcitrant warts: a novel proposition. J Cutan Med Surg. 2017;21(4):320-4.

Aktaş H, Ergin C, Demir B, Ekiz Ö Intralesional Vitamin D injection may be effective treatment option for warts. J Cutan med Surg. 2016;20(2):118-22.