Comparison of intradermal purified protein derivative (PPD) and vitamin D3 in the treatment of non-genital cutaneous warts

Background Viral warts are a common skin infection, usually on the hands, feet, or face of children and young adults, and are caused by the human papillomavirus (HPV) due to lower immune resistance. The common types seen in Pakistan are common warts, plantar warts, and flat warts, which cause pain or cosmetic concern among patients. Aims To compare and evaluate the efficacy of intralesional purified protein derivative (PPD) and vitamin D3 in the management of viral non-genital cutaneous warts. Methods A retrospective, comparative study was conducted at Nishtar Medical University Hospital, Multan, Pakistan from January to July 2023. A total of 266 patients with 1–10 viral warts were divided into two groups: Group I was given intralesional PPD (0.1 mL of 10 TU), and Group II was given intralesional vitamin D3 (0.5 mL of 600,000 IU), each given at 2-week intervals for a maximum of four doses. Summary The mean age of participants was 42.84 ± 13.29 years, with a male predominance (67.3%). Complete clearance of warts was significantly higher in the PPD group (85.7%) compared to the vitamin D3 group (71.4%; P = .005). Subgroup analysis revealed better outcomes with PPD in younger patients with multiple warts and specific anatomical locations (palmar, plantar, trunk), while vitamin D3 showed superior clearance for limb warts. Intralesional PPD demonstrated superior efficacy compared to vitamin D3 in the treatment of viral warts. Both therapies were safe and well-tolerated. This study provides direct comparative evidence of distinct immunological mechanisms, offering practical insights for the management of recalcitrant warts.