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LETTER
A recalcitrant case of facial verruca plana successfully treated
with topical calcipotriol alone
Dear Editor,
Verruca plana is a benign epidermal proliferative cutaneous condition
mainly caused by human papillomavirus (HPV) types 3 and 10. HPV
27, 28, 38, 41, and 49 may also rarely cause verruca plana.
1
Face
located plane warts usually cause important aesthetic concerns in
patients and lead them to seek treatment. The management of ver-
ruca plana poses a therapeutic challenge for clinicians, as there is no
single method that has been proven to be efficient for completely
treating the disease.
An 18-year-old woman presented with an 8 months history of
asymptomatic numerous small brown lesions on the chin. She was
otherwise healthy and her past medical history was unremarkable.
The lesions did not respond to previously treatments including oral
zinc, topical tretinoin, and topical adapalene. Dermatological examina-
tion revealed numerous, plane, yellowish to brown irregular papular
lesions ranging in size from 0.1 to 0.4 cm distributed on the left
side of the chin (Figure 1A). Dermatoscopic examination showed
numerous tiny dotted (pinpoint) vessels on a light brown background
(Figure 2). No other lesions were observed elsewhere. Based on the
clinical and dermatoscopic examinations, a diagnosis of verruca plana
was made. Daily simple application of topical calcipotriol ointment
allowed a complete resolution after 8 weeks without adverse reac-
tions (Figure 1B). No recurrence was observed during 6 months of
follow-up.
Common therapeutic options for verruca plana include cryother-
apy, electrocoagulation, topical salicylic acid, topical retinoids, topical
imiquimod, topical immunotherapy, laser or conventional/daylight
photodynamic therapy.
2,3
Most of these options may cause dys-
pigmentation, pain, and even scarring. Furthermore, no treatment has
been uniformly effective and, treatment resistance is common.
There are very few studies on the effectiveness of topical vitamin
D derivatives in the treatment of viral warts. Imagawa et al reported a
series of 17 cases of hand or foot located warts successfully treated
with topical maxacalcitol.
4
Egawa et al managed three immunocom-
promised cases with recalcitrant warts, using topical maxacalcitol with
a half-day occlusive dressing technique.
5
Labandeira et al reported a
case of giant wart successfully treated with topical calcipotriol.
6
Rind
et al reported the successful use of topical calcipotriol in a case of
anogenital wart in an infant.
7
Recently, it has been shown that intralesional vitamin D3 injec-
tion may be a simple, safe and cost-effective treatment modality
with minimal side effects. In a single-blinded placebo-controlled study
investigating effectivity of intralesional vitamin D3 injection in the
treatment of common warts, complete clearance of the target injected
warts occurred in 40% of patients in cases group, while it occurred
only in 5% of patients in control groups.
8
Topical vitamin D3 derivatives are considered as first-line therapy
in the treatment of chronic plaque psoriasis.
9
Biologic effects of
FIGURE 1 A, Verruca plana.
Numerous, plane, yellowish to
brown, irregular papular lesions
ranging in size from 0.1 to 0.4 cm
distributed on the left side of the
chin. B, Complete resolution of the
lesions after daily application of
topical calcipotriol for 8 weeks
Received: 8 February 2020 Revised: 17 May 2020 Accepted: 20 May 2020
DOI: 10.1111/dth.13664
Dermatologic Therapy. 2020;33:e13664. wileyonlinelibrary.com/journal/dth © 2020 Wiley Periodicals LLC. 1of2
https://doi.org/10.1111/dth.13664
