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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 6  |  Issue : 1  |  Page : 45-46

Successful treatment of multiple genital molluscum contagiosum with intralesional vitamin D3


Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra, India

Date of Submission18-Jun-2019
Date of Decision20-Apr-2020
Date of Acceptance18-May-2020
Date of Web Publication23-Jun-2020

Correspondence Address:
Dr. Bhushan Madke
Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdd.ijdd_35_19

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How to cite this article:
Bajaj S, Madke B, Henry D. Successful treatment of multiple genital molluscum contagiosum with intralesional vitamin D3. Indian J Drugs Dermatol 2020;6:45-6

How to cite this URL:
Bajaj S, Madke B, Henry D. Successful treatment of multiple genital molluscum contagiosum with intralesional vitamin D3. Indian J Drugs Dermatol [serial online] 2020 [cited 2020 Oct 24];6:45-6. Available from: https://www.ijdd.in/text.asp?2020/6/1/45/287429



Sir,

Molluscum contagiosum (MC) is a cutaneous viral infection caused by the molluscum contagiosum virus, a type of pox virus. In adults, genital MC is considered a sexually transmitted infection. Various treatment modalities are used to treat MC infection. However, in cases of extensive genital involvement, existing treatment modalities can be associated with significant morbidity (pain, infection, and scarring). Physical destruction with electrosurgery in the genital area can leave significant wounds and carries a risk of infection from anogenital flora. Intralesional immunotherapy is a novel way of treatment extensive cutaneous viral infection. Intralesional Vitamin D3 immunotherapy has been used in the past for the treatment of verruca vulgaris.[1],[2] We describe our experience of treating extensive genital MC infection with Vitamin D3 immunotherapy.

A 27-year-old immune-competent female presented with multiple skin-colored raised lesions on her inner aspect of thighs and external genitalia. She reported that the lesions started appearing 6 weeks back and were increasing in size and number for the past 6 weeks. She was a mother of two children and was tubectomized after her second delivery. She denied any high-risk sexual behavior. Her husband did not report any similar lesions either of genitalia or elsewhere on the skin surface. Screening for signs of other sexually transmitted infections was negative in patient and spouse. On cutaneous examination, the patient had multiple skin-colored papules and nodules on the inner aspect of both thighs and external genitalia [Figure 1]. The papules and nodules were coalescing to form a fleshy mass at places, and lesions remained discrete on external genitalia. The perianal area remained clear of the pathology. Serology for retroviral infection and syphilis was negative. Crush smear from one of the lesions confirmed the diagnosis of MC. The patient insisted on less painful treatment and wanted minimal scarring.
Figure 1: Extensive involvement of upper inner aspect of thighs and genitalia with molluscum contagiosum (day 0)

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We counseled about the experimental nature of using intralesional Vitamin D3. After obtaining a signed and informed consent, we treated the area with intralesional Vitamin D3. Vitamin D3 for injection is available in vials containing 600,000 IU of cholecalciferol in 1 ml (15 mg) in an oily base. After cleansing the lesions with soap and water, three lesions selected randomly were injected with 0.2 ml (8 units), 0.2 ml (8 units), and 0.1 ml (4 units) of drug, respectively, with an insulin syringe (40 units = 1 ml) in the substance of lesion. A total of 0.5 ml was injected at one treatment session. The patient was counseled about the painful nature of injection since the drug is formulated in an oily vehicle. The patient was prescribed a combination of ibuprofen (400 mg) and paracetamol (325 mg) to be taken orally for severe pain as needed. After 3 weeks at follow--up, we noticed significant resolution of lesions with few lesions persisting [Figure 2].
Figure 2: Postintralesional Vitamin D3 showing significant resolution of lesions (day 21)

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Immunotherapy is defined as a type of biological therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection, and other diseases.[3] The exact mechanism by which Vitamin D3 immunotherapy works is still unclear. It is postulated that Vitamin D3 has immunomodulatory and immunostimulatory properties by inhibiting the expression of interleukin-6 (IL-6), IL-8, tumor necrosis factor (TNF)-α and TNF-γ mediated through Vitamin D receptor (VDR)-dependent pathway.[4] In addition, Vitamin D3 acts on toll-like receptor activation, which causes human macrophages up-regulation and expression of VDR and Vitamin D1-hydroxylase genes, leading to expression and secretion of antimicrobial peptides and boosting innate immune responses.[5] Workers have used intralesional Vitamin D3 in the treatment of common warts and palmoplantar warts; however, its use in extensive MC infection has not been reported previously. One critical argument can crop up whether the response to intralesional Vitamin D3 is real or not, in the authors opinion, the response is real since the resolution started within a week of giving intralesional therapy and continued till the day of follow-up (day 21). In view of the above reason, we feel that the resolution of lesions is not spontaneous, but the effect of intralesional Vitamin D3. Near-complete resolution of the lesion with a single session of intralesional Vitamin D 3 could be explained by prior sensitization by either oral or parenteral Vitamin D3 therapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kavya M, Shashikumar BM, Harish MR, Shweta BP. Safety and efficacy of intralesional Vitamin D3 in cutaneous warts: An open uncontrolled trial. J Cutan Aesthet Surg 2017;10:90-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Raghukumar S, Ravikumar BC, Vinay KN, Suresh MR, Aggarwal A, Yashovardhana DP. Intralesional Vitamin D (3) injection in the treatment of recalcitrant warts: A novel proposition. J Cutan Med Surg 2017;21:320-4.  Back to cited text no. 2
    
3.
Thappa DM, Chiramel MJ. Evolving role of immunotherapy in the treatment of refractory warts. Indian Dermatol Online J 2016;7:364-70.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
AlGhamdi K, Kumar A, Moussa N. The role of Vitamin D in melanogenesis with an emphasis on vitiligo. Indian J Dermatol Venereol Leprol 2013;79:750-8.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Aktaş H, Ergin C, Demir B, Ekiz Ö. Intralesional Vitamin D injection may be effective treatment option for warts. J Cutan Med Surg 2016;20:118-22.  Back to cited text no. 5
    


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