الفهرس 
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Abstract
Cutaneous warts are the result of infection of the epidermis with human papilloma virus (HPV). Different HPV types are responsible for particular clinical varieties such as common, plane, plantar, mosaic, ano-genital and oral warts.
Warts are refractory to treatment. Many lines of treatment are available but non is eradicative and most of them have limited efficacy and show relapse. Numerous therapeutic modalities are available for warts with variable success rates. These include topical therapies such as salicylic acid, tretinoin, podophyllotoxin, trichloroacetic acid, formaldehyde, 5-fluorouracil, photodynamic therapy and surgical/cytotoxic modalities such as cryotherapy, laser ablation, intralesional bleomycin, electrocautery, and surgical excision. Immunomodulating agents have generated considerable interest as it is well known that cell mediated immunity is involved in the clearance of cutaneous warts. Several intralesional antigens have been tried including MMR (measles, mumps, rubella) vaccine, skin test antigens (mumps, Candida, Trichophyton), BCG (Bacillus Calmette-Guerin) vaccine, and Candida antigen.
It is evident that ultraviolet radiation enables vitamin D3 (cholecalciferol) formation in the epidermis, and this product is further converted into the active metabolites 25-hydroxycholecalciferol and 1,25-hydroxycholecalciferol, which exert several important effects on the skin. It is believed that most tissues have the ability to convert vitamin D3 into its active form, 1,25(OH)2D3, which in turn binds to the VDR and forms the 1,25(OH)2D3/VDR complex, which subsequently regulates the expression of several genes.
Vitamin D has the property to regulate epidermal proliferation and cytokine production and, when used as an intralesional injection, serves as an immunotherapeutic agent. Hence, this study was undertaken to explore this potential effect of vitamin D in the treatment of multiple extragenital warts.
Our aim in this study is to evaluate the efficacy and safety of intralesional vitamin D3 treatment for warts.
Cases were selected from dermatology outpatient clinic, Faculty of Medicine, Menoufia University Hospital during the period from December 2015 to April 2017. All cases were subjected to complete history taking. Both general and dermatological examination was performed. Seventy patients with single or multiple warts were included in this study. Amongst the 70 patients, 50 patients were treated with intralesional injection of vitamin D3 and 20 patients were treated with intralesional injection of saline. For vitamin D3 group, 0.3ml of vitamin D3(200,000 iu) solution was injected into the base of each wart after 0.1 ml of mepacaine injection. A maximum of 5 warts were treated in 1 session, with a maximum of 3 injections performed at 2-week intervals. And for the saline group, Each lesion was injected with 0.3 ml of saline (NaCl 0.9%) slowly in the base of each wart using a 21 gauge syringe. Injections were performed each two weeks for a maximum of 3 sessions. Patients were followed up for 6 months after the last injection to detect recurrence and side effects.
In the vitamin D3 group, 42 of 50 patients (84%) showed complete resolution of warts. While 2 (4%) patients showed partial resolution. Six (12%) patients failed to show any response. No recurrence or serious adverse effects were observed. The average number of injections required for total disappearance in the complete clearance group was 2. Complete clearance was not seen in any patient in the saline group. Partial response was seen in 2 (10%) of the patients, while no response was detected in 18 (90%) of the patients in the saline group.