Role of Vitamin D in Treatment of Warts: Review Article

Abstract

Viral warts are common cutaneous lesions associated with human papillomavirus (HPV) infection and may be difficult to treat, particularly when lesions are multiple, large, or recalcitrant. Conventional destructive treatment modalities may be painful, may cause scarring, and usually target only treated lesions without affecting distant warts. Vitamin D has emerged as a promising therapeutic option because of its effects on keratinocyte proliferation and differentiation as well as its immunomodulatory activity. Vitamin D may enhance cell-mediated immune responses against HPV through activation of toll-like receptor pathways, induction of antimicrobial peptides, and regulation of several inflammatory cytokines. Both topical vitamin D analogues and intralesional vitamin D3 have shown encouraging results in the treatment of different types of warts, with previous studies reporting high clearance rates, limited adverse effects, and low recurrence. These findings support further evaluation of vitamin D as an effective and relatively safe therapeutic approach for viral warts. Vitamin D has attracted increasing attention in the management of viral warts because of its combined antiproliferative and immunomodulatory effects. In the skin, active vitamin D interacts with vitamin D receptors in keratinocytes, helping to regulate epidermal proliferation and differentiation, while also influencing local immune responses. Its role in enhancing antimicrobial peptide production and modulating cytokines such as interleukin-6, interleukin-8, tumor necrosis factor-α, and interferon-gamma may contribute to improved immune recognition and clearance of HPV-infected cells. This immunologic effect is particularly relevant in patients with multiple or recalcitrant warts, where conventional destructive therapies may be less practical or associated with pain, scarring, and recurrence. Previous studies of intralesional vitamin D3 have demonstrated encouraging therapeutic responses with relatively low recurrence rates, supporting its potential role as an alternative immunotherapeutic modality for resistant warts.