Intralesional Vitamin D3, Zinc Sulfate, and Topical Potassium Hydroxide for the Treatment of Recalcitrant Warts: A Three-armed Randomized Controlled Study

BackgroundWarts are benign epidermal proliferations caused by the human papillomavirus. The current therapies are either destructive, leading to scar formation, or less effective, causing recurrences. Therefore, the study aims to investigate the efficacy and safety of vitamin D3, zinc sulfate, and potassium hydroxide for the treatment of recalcitrant warts.MethodsA three-arm randomized controlled clinical trial was carried out in the Dermatology, Andrology, and Sexually Transmitted Diseases Department of Mansoura University Hospitals, Dakahlia, Egypt, from August 2022 to May 2023. Eighty patients were randomly recruited into 4 groups, including Intralesional injections of vitamin D3 (group 1), zinc sulfate 2% (group 2), potassium hydroxide 10% (group 3), and normal saline (group 4). The dermoscopic examination was used to diagnose and monitor treatment.ResultsThere was statistically significant therapeutic improvement in groups 1, 2, and 3 compared to the control group (P 0.001). complete cure was achieved after 6 weeks of therapy in 75%, 70%, and 55% of patients in groups 1, 2, and 3, respectively, with a statistically insignificant correlation with the control group (P >0.05). The best responses involved all types of warts treated with vitamin D3. Common warts were highly responsive to zinc sulfate (90% of the patients), while plane warts were 100% responsive to potassium hydroxide. Recurrences were observed only in groups 1 (5%, n = 1) and 2 (15%, n = 3).ConclusionIntraregional administration of vitamin D3, zinc sulfate 2%, and potassium hydroxide 10% was effective and safe for the treatment of recalcitrant warts.