Immunotherapeutic modalities for the treatment of recalcitrant plantar warts: a comparative study.

Background: Plantar warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy has been used as a promising alternative therapeutic option in such recalcitrant cases.

Objective: To evaluate and compare the efficacy and safety of the intralesional injection of vitamin D3, zinc sulfate 2%, and Candida antigen in the treatment of recalcitrant plantar warts.

Methods: The study included 152 adult patients with single or multiple recalcitrant plantar warts. They were equally subdivided into four groups (38 patients in each): 2% zinc sulfate, vitamin D3, Candida antigen, and normal saline respectively. Injections were done at 3-week intervals until complete resolution or for a maximum of 4 sessions.

Results: Complete response was achieved in 20 patients (52.7%) of the zinc sulfate group, 34 patients (89.5%) of the intralesional vitamin D3 group, 25 patients (65.7%) of the intralesional Candida antigen group and 8 patients (21.2%) of the saline group. The difference between the groups was statistically significant in favor of vitamin D3 (p = .037).

Conclusions: Recalcitrant plantar warts were best treated with vitamin D3 that also has the advantages of better response on distant warts, minimal side effects, and low rate of wart recurrence.