Intralesional Immunotherapy Agents Show Promising Outcomes in Plantar Warts

Immunotherapy using zinc sulfate and vitamin D3 may be promising treatment options for plantar warts.

Intralesional 2% zinc sulfate and vitamin D3 are effective treatments for plantar warts, according to study results published in Dermatologic Therapy.

Common treatments for plantar warts include cryotherapy, topical salicylic acid, and laser surgery; however, response to these treatments is highly variable. The objective of this study was to evaluate and compare the efficacy of intralesional 2% zinc sulfate solution with intralesional vitamin D, as well as side effects, in the treatment of plantar warts.

In the study, researchers evaluated 105 patients with plantar warts from the Dermatology outpatient clinic at Ain-Shams University Hospital from July 2018 through May 2019. Patients were divided into 3 groups of 35. Intralesional 2% zinc sulfate injections were administered to the first group, intralesional 2% vitamin D3 was given to the second group, and normal saline injections were given to the third group. All patients received 1 injection every 2 weeks for a total of 4 sessions, and patients were followed up every 2 weeks until 6 weeks after the last treatment session for 3 months.

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Results revealed that at study conclusion, the complete response rate was highest in  patients who received zinc (71.4%) and vitamin D3 (62.9%) compared with patients who received saline (40%). A  statistically significant difference was observed between the 3 groups in regard to pain during injection (P <.001), with severe pain reported in 48.6% of patients who received zinc, mild pain reported in 80% of patients who received vitamin D3, and no pain reported in 57.1% of patients who received saline.

The study researchers concluded that intralesional 2% zinc sulfate is more effective than vitamin D3 at treating plantar warts, although both treatments are effective; however, zinc sulfate may cause severe pain during the injection, which may limit its acceptance by most patients.

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El Sayed MH, Sayed FS, Afify AA. Intralesional zinc sulfate 2% versus intralesional vitamin D in plantar warts: a clinicodermoscopic study [published online March 12, 2020]. Dermatol Ther. doi: 10.1111/dth.13308