INTRODUCTION
Many treatment methods exist for treating plantar warts, yet high rates of treatment failure are reported and no one single treatment is regarded optimal for curing the condition. Up to 1 in 4 patients seek multiple modalities to cure the warts and report these to be unsatisfactory.1,2,3
Vitamin D is a fatâ€soluble steroid prohormone that exerts its action through endocrine, paracrine and intracrine axis. A wide set of biological functions such as controlling cellular proliferation, migration as well as angiogenesis. Moreover, vitamin D deficiency has been established in a wide set of skin diseases such as psoriasis, alopecia, acne and atopic dermatitis. Vitamin D induces macrophage stimulation and formation of cathelicidins.4
The exact mechanism of antigen injection for wart treatment (immunotherapy) remains to be fully elucidated. However, a number of different antigens have been used for different form of warts and proven different degrees of success.5 Candida antigen was used earlier for wart treatments and postulated to exert its action not only on injected warts but distant warts as well through stimulation of cellâ€mediated immune response and recruitment of various immune cells (ie, neutrophils, lymphocytes) and release of cytokines (eg, TNFâ€Î±, ILâ€1, ILâ€6,IFNâ€Î³, GMâ€CSF).6
Vitamin D is a fatâ€soluble steroid prohormone that exerts its action through endocrine, paracrine and intracrine axis. A wide set of biological functions such as controlling cellular proliferation, migration as well as angiogenesis. Moreover, vitamin D deficiency has been established in a wide set of skin diseases such as psoriasis, alopecia, acne and atopic dermatitis. Vitamin D induces macrophage stimulation and formation of cathelicidins.4
The exact mechanism of antigen injection for wart treatment (immunotherapy) remains to be fully elucidated. However, a number of different antigens have been used for different form of warts and proven different degrees of success.5 Candida antigen was used earlier for wart treatments and postulated to exert its action not only on injected warts but distant warts as well through stimulation of cellâ€mediated immune response and recruitment of various immune cells (ie, neutrophils, lymphocytes) and release of cytokines (eg, TNFâ€Î±, ILâ€1, ILâ€6,IFNâ€Î³, GMâ€CSF).6
PATIENTS AND METHODS
Patients
The study included forty patients who were divided into two groups (A&B) with 20 patients each. Group A received intralesional vitamin D3 while Group B received intralesional Candida antigen. Injection was done every 3 weeks until clearance of warts or a maximum of three treatments. Patients' consents and ethical committee approval were both obtained before onset of the trial.
Patients with three or more recurrent or recalcitrant warts and who tested positive for candida antigen and aged 20–40 were included in this trial. Those receiving warts treatments during the previous month to onset of trial and those with hypersensitivity to candida antigen or to Vitamin D, pregnant or lactating females, were all excluded from the study. Moreover, those with skin disease or reported immunosuppression were excluded.
Injection Technique
For group A patients, 0.1 ml of candida antigen was used first to test hypersensitivity by injection into the side of the forearm. Those who tested positive with an induration and erythema of ≥5 mm after 48–72 hours were only included in the study (positive responders). Those positive responders then received intralesional 0.1 mL of Candida antigen in the biggest wart.
The study included forty patients who were divided into two groups (A&B) with 20 patients each. Group A received intralesional vitamin D3 while Group B received intralesional Candida antigen. Injection was done every 3 weeks until clearance of warts or a maximum of three treatments. Patients' consents and ethical committee approval were both obtained before onset of the trial.
Patients with three or more recurrent or recalcitrant warts and who tested positive for candida antigen and aged 20–40 were included in this trial. Those receiving warts treatments during the previous month to onset of trial and those with hypersensitivity to candida antigen or to Vitamin D, pregnant or lactating females, were all excluded from the study. Moreover, those with skin disease or reported immunosuppression were excluded.
Injection Technique
For group A patients, 0.1 ml of candida antigen was used first to test hypersensitivity by injection into the side of the forearm. Those who tested positive with an induration and erythema of ≥5 mm after 48–72 hours were only included in the study (positive responders). Those positive responders then received intralesional 0.1 mL of Candida antigen in the biggest wart.
