Effectiveness of Intralesional Vitamin D and Bleomycin Injections in Treating Recalcitrant Plantar Wart: A Comparative Study

Samar Ahmed Jasim; Rana Helmi; Shaymaa Khalid Abdulqader

doi:10.54133/ajms.v9i1.2124

Authors

Samar Ahmed Jasim Department of Dermatology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0009-0001-4669-5691
Rana Helmi Department of Dermatology, College of Medicine, Mustansiriyah University, Baghdad, Iraq
Shaymaa Khalid Abdulqader Department of Radiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq https://orcid.org/0000-0001-7029-0451

DOI:

https://doi.org/10.54133/ajms.v9i1.2124

Keywords:

Adult, Adverse effects, Bleomycin, Intralesional injection, Vitamin D, Warts

Abstract

Background: Intralesional injections of vitamin D and bleomycin have gained growing clinical interest in the treatment of recalcitrant plantar warts, with pain as a major limitation associated with their use. Objective: To assess the clinical outcomes of vitamin D and bleomycin in managing treatment-resistant plantar warts. Methods: An interventional comparative study conducted on patients diagnosed with recalcitrant plantar warts over 9 months and not treated for two months. Patients were divided randomly into two groups: group A (24 patients received intralesional vitamin D) and group B (24 patients received intralesional bleomycin). The clearance rate and pain score were estimated by visual analogue scale (VAS). Results: 48 patients were enrolled in the study. Bleomycin produced a significantly greater reduction in wart size at early time points (2, 4, 6, and 8 weeks). Vitamin D also resulted in wart size reduction but with less consistency. By the 4-month follow-up, both treatment groups showed substantial clearance, with no statistically significant difference in overall outcomes. Vitamin D produced significantly lower pain scores at 1, 2, and 3 weeks, indicating better tolerability. By week 8, VAS scores between the groups converged and were no longer significantly different. Conclusions: Intralesional bleomycin and vitamin D are effective in the treatment of recalcitrant plantar warts. Bleomycin produced more rapid lesion regression, whereas vitamin D exhibited a more favorable tolerability profile.

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References

Witchey DJ, Witchey NB, Roth-Kauffman MM, Kauffman MK. Plantar warts: Epidemiology, pathophysiology, and clinical management. J Am Osteopath Assoc. 2018;118(2):92-105. doi: 10.7556/jaoa.2018.024. DOI: https://doi.org/10.7556/jaoa.2018.024

Zhu P, Qi RQ, Yang Y, Huo W, Zhang Y, He L, et al. Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). J Evid Based Med. 2022;15(3):284-301. doi: 10.1111/jebm.12494. DOI: https://doi.org/10.1111/jebm.12494

Hosseini MS, Sadeqi A, Heidari Z, Boozari M. A comprehensive review of biologically active natural products on human papillomavirus (HPV) at a glance. Phytother Res. 2025;39(5):2262-2290. doi: 10.1002/ptr.8444. DOI: https://doi.org/10.1002/ptr.8444

Fathy G, Sharara MA, Khafagy AH. Intralesional vitamin D3 versus Candida antigen immunotherapy in the treatment of multiple recalcitrant plantar warts: A comparative case-control study. Dermatol Ther. 2019;32(5):e12997. doi: 10.1111/dth.12997. DOI: https://doi.org/10.1111/dth.12997

Martin A, Thatiparthi A, Nourmohammadi N, Nguyen C, Sung C, Atanaskova Mesinkovska N. Emerging intralesional treatments for plantar warts: A systematic review. J Drugs Dermatol. 2022;21(12):1322-1329. doi: 10.36849/JDD.6735. DOI: https://doi.org/10.36849/JDD.6735

Ranjan S, Sharma P, Dogra D. A hospital-based single-arm study to assess the efficacy of intralesional bleomycin injection in patients of resistant periungual and palmoplantar warts. J Skin Sex Transm Dis. 2024;6:144-149. doi: 10.25259/JSSTD_39_2024. DOI: https://doi.org/10.25259/JSSTD_39_2024

Aryal E, Bhari J, Shrestha PR. Immunotherapy with intralesional vit D injection in recalcitrant wart at a tertiary care center: A Descriptive cross sectional study. J Nepal Med Assoc. 2024;62(274):378-381. doi: 10.31729/jnma.8614. DOI: https://doi.org/10.31729/jnma.8614

Abdulqader S, Bakr GM, Ahmed SA, Hassan QA, Al-Kinani M. Gender distribution of coronary artery calcium score and degree of stenosis assessed by computed tomography angiography in Iraqi patients with chest pain. Al-Rafidain J Med Sci. 2024;7(1):78–84. doi: 10.54133/ajms.v7i1.1032. DOI: https://doi.org/10.54133/ajms.v7i1.1032

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;29(8):e13442. doi: 10.1111/srt.13442. DOI: https://doi.org/10.1111/srt.13442

Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240-252. doi: 10.1002/acr.20543. DOI: https://doi.org/10.1002/acr.20543

Puri N. A study on the efficacy of intralesional bleomycin for the treatment of periungual and palmoplantar warts. Int J Res Dermatol. 1010;6(3):352–354. doi: 10.18203/issn.2455-4529.IntJResDermatol20201579. DOI: https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20201579

Marahatta S, Khadka DK, Agrawal S, Rijal A. Intralesional bleomycin for the treatment of resistant palmoplantar and periungual warts. Dermatol Res Pract. 2021;2021:8655004. doi: 10.1155/2021/8655004. DOI: https://doi.org/10.1155/2021/8655004

Nasr M, Abdelaty S, Elkholy BM. A comparative clinico-dermoscopic study of intralesional injection of combined digoxin and furosemide, Candida antigen, and vitamin D3 for multiple warts. J Cosmet Dermatol. 2023;22(4):1344-1353. doi: 10.1111/jocd.15581. DOI: https://doi.org/10.1111/jocd.15581

Priya A, Adil M, Amin SS, Mohtashim M, Bansal R, Alam M. Intralesional vitamin D3 in recalcitrant palmoplantar and periungual warts: A prospective, observational study. Acta Dermatovenerol Croat. 2019;27(4):215-224. PMID: 31969233.

Prathibha JP, Varghese N, Aithal VV. Intralesional vitamin D3 versus bleomycin for difficult-to-heal palmoplantar warts: A comparative study. J Cutan Aesthet Surg. 2023;16(2):114-120. doi: 10.4103/JCAS.JCAS_128_21. DOI: https://doi.org/10.4103/JCAS.JCAS_128_21

Abdelaal MA, Abdelaziz HM, Ahmed KA, Elsaie ML. Comparative study of intralesional vitamin D3 injection and Candida albicans antigen in treating plantar warts. J Drugs Dermatol. 2021;20(5):546-549. doi: 10.36849/JDD.5264.

Elsayed Ghaly N, El-Ashmawy AA, Abou Zeid M, E Shaker ES. Efficacy and safety of intralesional injection of vitamin D3 versus tuberculin PPD in the treatment of plantar warts: A comparative controlled study. J Cosmet Dermatol. 2021;20(4):1231-1240. doi: 10.1111/jocd.13712. DOI: https://doi.org/10.1111/jocd.13712

Nofal A, Albalat W, Ismail A, Khattab FM. Immunotherapeutic modalities for the treatment of recalcitrant plantar warts: a comparative study. J Dermatolog Treat. 2022;33(2):922-927. doi: 10.1080/09546634.2020.1789540. DOI: https://doi.org/10.1080/09546634.2020.1789540

Christhudasan CC, Thangaraja A, Hameed H. (2024). Comparison of pain relief among patients with chronic plantar fasciitis treated with intralesional platelet-rich plasma injection versus corticosteroid injection in a tertiary care centre in Kerala - a prospective study. Int J Res Orthopaed. 2024;10(3):582–587. doi: 10.18203/issn.2455-4510.intjresorthop20241108. DOI: https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20241108

Aziz-Jalali M, Ghafarpour G, Rezaei M R, Heshmatzadeh Behzadi A, Rohani Nasab M, et al. Efficacy of intralesional bleomycin in the treatment of resistant warts. J Skin Stem Cell. 2014;1(1):e18875. doi: 10.17795/jssc18875. DOI: https://doi.org/10.17795/jssc18875

Singh Y, Rajamohanan RR, Vasudevan S, Kuruvila S. Effectiveness of intralesional bleomycin in the management of difficult-to-treat and resistant cutaneous warts in a tertiary care teaching hospital in Puducherry: A quasi-experimental study. J Cutan Aesthet Surg. 2025;18(2):108-113. doi: 10.25259/jcas_71_24. DOI: https://doi.org/10.25259/jcas_71_24