COMPARISON OF EFFICACY OF ORAL ZINC SULFATE VERSUS INTRALESIONAL VITAMIN D3 IN THE TREATMENT OF VIRAL WARTS
DOI:
https://doi.org/10.70520/kjms.v19i1.693Keywords:
Efficacy, Immunotherapy, Quasi-experimental, Recurrence, Viral warts, Zinc SulfateAbstract
Objective: To compare the efficacy of oral zinc sulphate versus intralesional vitamin D3 in the treatment of viral warts.
Methods: This comparative quasi-experimental study was conducted at the Department of Dermatology, MTI-Hayatabad Medical Complex, Peshawar, from 01 July 2024 to 01 January 2025, after approval from the Institutional Research & Ethical Board (IREB) (Approval No: 1743). A total of 60 patients (12–70 years) with clinically diagnosed viral warts were enrolled through non-probability consecutive sampling. Participants were allocated into two groups based on treatment preference (non-randomised): Group A (n=30) received intralesional vitamin D3 injections (600,000 IU; 0.2 mL into the base of lesions) every two weeks for eight weeks, while Group B (n=30) received oral zinc sulphate (10 mg/kg/day) for eight weeks. Treatment response at week 8 was categorised as excellent (>90% clearance), good (75–90%), poor (50–74%), or no response (<50%). Patients were followed for three months to assess recurrence. Data were analysed using SPSS version 23.0; chi-square test was applied and p<0.05 was considered statistically significant.
Results: Mean age was 39.33±14.48 years in the vitamin D3 group and 37.50±13.75 years in the zinc sulphate group. Excellent response was observed in 60.0% (18/30) patients receiving vitamin D3 and 56.7% (17/30) receiving zinc sulphate (p=0.840). Recurrence at three months occurred in 33.3% (10/30) and 23.3% (7/30) patients, respectively (p=0.390).
Conclusion: Oral zinc sulphate and intralesional vitamin D3 showed comparable efficacy for viral warts, with no statistically significant difference in short-term recurrence.
References
1. Al Aboud AM, Nigam PK. Wart. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431047/
2. Al-Gurairi FT, Al-Waiz M, Sharqiue KE. Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial. Br J Dermatol. 2021;146(3):423-31.
3. Noureen U, Shah RR, Waqas N, Sharif S, Shah A, Rao BK, et al. Efficacy of intralesional Vitamin D3 for treatment of verruca vulgaris: a randomized control study. J Clin Aesthet Dermatol. 2023;16(8):47-50.
4. Mun JH, Kim SH, Jung DS, Ko HC, Kim BS, Kwon KS, et al. Oral zinc sulfate treatment for viral warts: an open-label study. J Dermatol. 2011;38(6):541-5.
5. Abd El-Magid WM, Nada EEA, Mossa RA. Intralesional injection of vitamin D3 versus zinc sulfate 2% in the treatment of plantar warts: a comparative study. J Dermatolog Treat. 2021;32(3):355-360.
6. Mun JH, Kim SH, Jung DS, Ko HC, Kim BS, Kwon KS, et al. Oral zinc sulfate treatment for viral warts: an open-label study. J Dermatol. 2011;38(6):541-5.
7. Noureen U, Shah RR, Waqas N, Sharif S, Shah A, Rao BK, et al. Efficacy of intralesional Vitamin D3 for treatment of verruca vulgaris: a randomized control study. J Clin Aesthet Dermatol. 2023;16(8):47-50.
8. Aktas H, Ergin C, Demir B, et al. Intralesional vitamin D injection may be an effective treatment option for warts. J Cutan Med Surg. 2016;20:118-122.
9. 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 Aug;29(8):e13442.
10. Latif I, Sultan J, Aslam A, Hassan T, Devi R. Role of intralesional vitamin D3 in the treatment of cutaneous warts. J Cutan Aesthet Surg. 2021;14(4):404-408.
11. Rindfleisch JA, Muller D. Diagnosis and management of warts. Am Fam Physician. 2021;104(2):113-120.
12. Bruggink SC, de Koning MN, Gussekloo J, et al. HPV type in plantar warts influences natural course and treatment response: a cohort study. J Invest Dermatol. 2019;139(2):512-518.
13. Sinha S, Relhan V, Garg VK. Vitamin D3 as an alternative treatment for recalcitrant warts: a review. J Am Acad Dermatol. 2020;82(1):248-256.
14. Vakharia PP, Chopra R, Silverberg NB. Systemic therapy for warts: A review. J Am Acad Dermatol. 2021;85(5):1211-1224.
15. Huo W, Zhu Y, Zhang H, et al. The role of vitamin D in immune-mediated skin diseases: pathogenesis, clinical implications, and therapeutic strategies. Exp Dermatol. 2022;31(5):658-671.
16. Al Abadie MS, Senior HJ, Bleehen SS. The role of zinc in the treatment of warts: A double-blind placebo-controlled study. Br J Dermatol. 2021;145(1):70-75.
17. Thappa DM, Chiramel MJ. Efficacy and safety of intralesional vitamin D3 in the treatment of cutaneous warts: A systematic review. Dermatol Ther. 2021;34(2):e14742.
18. Karadag AS, Ozlu E, Yildizgören MT. Intralesional vitamin D3 injection for the treatment of multiple recalcitrant warts: A prospective study. Dermatol Ther. 2021;34(1):e14712.
19. Lipke MM. An armamentarium of wart treatments. Clin Med Res. 2020;8(3-4):162-172.
20. Kwok CS, Holland R, Gibbs S. Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials. Br J Dermatol. 2023;188(4):551-560.
