{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:46:08Z","timestamp":1790027168616,"version":"4.0.1"},"reference-count":52,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:00:00Z","timestamp":1767830400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cutaneous warts are common benign lesions caused by human papillomavirus and often resist conventional treatments. Intralesional immunotherapy with measles\u2013mumps\u2013rubella (MMR) vaccine or vitamin D3 has emerged as an alternative, but their comparative efficacy and safety remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta\u2010analysis of nine randomized controlled trials (RCTs) including 742 patients comparing intralesional MMR with vitamin D3 for nongenital cutaneous warts. We searched PubMed, Cochrane CENTRAL, and ScienceDirect up to June 2025, and the protocol was registered in PROSPERO (ID: 1128443). Primary outcomes were complete, partial, and no response; secondary outcomes were recurrence and adverse events (erythema, pain, swelling). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Vitamin D3 achieved lower complete clearance than MMR (RR 0.85; 95% CI 0.75\u20130.96;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and a higher risk of no response (RR 2.40; 95% CI 1.40\u20134.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). No significant differences were seen for partial response (RR 1.24; 95% CI 0.94\u20131.64;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.13;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), recurrence (RR 2.20; 95% CI 0.73\u20136.58;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.16), or pain (RR 0.92; 95% CI 0.74\u20131.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.46). Vitamin D3 was linked to more swelling (RR 2.79; 95% CI 1.15\u20136.75;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), while MMR was associated with more erythema (RR 0.60; 95% CI 0.42\u20130.86;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intralesional MMR appears to be more effective than vitamin D3 for cutaneous warts, with superior clearance and distinct adverse event profiles. Larger, standardized trials are warranted to validate these effect sizes and optimize treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocd.70618","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T08:12:41Z","timestamp":1767859961000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Efficacy and Safety of Intralesional\n                    <scp>MMR<\/scp>\n                    Vaccine and Vitamin\n                    <scp>D3<\/scp>\n                    in Managing Nongenital Warts: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1593-0622","authenticated-orcid":false,"given":"Rahul","family":"Balach","sequence":"first","affiliation":[{"name":"Ziauddin University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1928-7100","authenticated-orcid":false,"given":"Ayan","family":"Khalid","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3419-6285","authenticated-orcid":false,"given":"Anas","family":"Rasool","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4159-4453","authenticated-orcid":false,"given":"Aamna","family":"Kashif","sequence":"additional","affiliation":[{"name":"Faisalabad Medical University  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Ahmad","sequence":"additional","affiliation":[{"name":"CMH Lahore Medical College  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aroosa","family":"Zafar","sequence":"additional","affiliation":[{"name":"POF Hospital, Wah Medical College  Wah Cantt Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1761-6231","authenticated-orcid":false,"given":"Muhammad","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Ziauddin University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aamir Shahid","family":"Javed","sequence":"additional","affiliation":[{"name":"CMH Lahore Medical College  Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misha","family":"Hasan","sequence":"additional","affiliation":[{"name":"Ziauddin University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4300-5941","authenticated-orcid":false,"given":"Somaiya","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Sir Salimullah Medical College  Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,8]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.7556\/jaoa.2018.024"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.18203\/issn.2455\u20104529"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/2277\u20109175.129701"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.16280"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.25259\/IJDVL_1669_2024"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjidi.2024.100264"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijd.ijd_890_23"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.78337"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.13272"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.15813"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1123933"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468\u20103083.2010.03611.x"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.07.003"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.70782"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010016\u20100384\u20104"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780140406"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.14335"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.13034"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.4103\/idoj.IDOJ_111_18"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1155\/2024\/5236290"},{"issue":"5","key":"e_1_2_12_26_1","first-page":"15","article-title":"Therapeutic Outcome of Intralesional Immunotherapy in Cutaneous Warts Using the Mumps, Measles, and Rubella Vaccine: A Randomized, Placebo\u2010Controlled Trial","volume":"11","author":"Awal G.","year":"2018","journal-title":"Journal of Clinical and Aesthetic Dermatology"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.12997"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pdpdt.2020.101979"},{"issue":"11","key":"e_1_2_12_29_1","first-page":"26","article-title":"A Comparative Study of Intralesional Vitamin D3, Measles Mumps Rubella Vaccine, and Tuberculin Purified Protein Derivative in the Treatment of Recalcitrant Warts: An Approach to Solve a Therapeutic Conundrum","volume":"14","author":"Jain S.","year":"2021","journal-title":"Journal of Clinical and Aesthetic Dermatology"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.25259\/IJDVL_1369_20"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.12882"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijd.IJD_700_20"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms26125644"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2023.1260139"},{"issue":"2","key":"e_1_2_12_35_1","first-page":"44","article-title":"Comparative Study Between Intralesional MMR and Intralesional BCG in Treatment of Verruca Vulgaris","volume":"17","author":"Munnangi P.","year":"2018","journal-title":"IOSR Journal of Dental and Medical Sciences"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.15570\/actaapa.2021.1"},{"issue":"1","key":"e_1_2_12_37_1","first-page":"10","article-title":"Intralesional Injection of the Measles\u2010Mumps\u2010Rubella Vaccine Into Resistant Palmoplantar Warts: A Randomized Controlled Trial","volume":"44","author":"Rezai M. S.","year":"2019","journal-title":"Iranian Journal of Medical Sciences"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.12230"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.13921"},{"issue":"4","key":"e_1_2_12_40_1","first-page":"598","article-title":"Role of Intralesional Vitamin\u2010D in Viral Wartse","volume":"33","author":"Zainab Z.","year":"2021","journal-title":"Journal of Ayub Medical College"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.14280"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.4103\/idoj.IDOJ_573_20"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.15564"},{"issue":"8","key":"e_1_2_12_44_1","first-page":"40","article-title":"Intralesional Immunotherapy With Measles Mumps Rubella Vaccine for the Treatment of Anogenital Warts: An Open\u2010Label Study","volume":"13","author":"Sharma S.","year":"2020","journal-title":"Journal of Clinical and Aesthetic Dermatology"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/ddg.13878"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.2174\/0929867013371950"},{"issue":"8","key":"e_1_2_12_47_1","first-page":"47","article-title":"Efficacy of Intralesional Vitamin D3 for Treatment of Verruca Vulgaris: A Randomized Control Study","volume":"16","author":"Noureen U.","year":"2023","journal-title":"Journal of Clinical and Aesthetic Dermatology"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.15581"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.4103\/JCAS.JCAS_82_16"},{"issue":"18","key":"e_1_2_12_50_1","first-page":"5083","article-title":"The Effect of Vitamin D3 on the Production of Cytotoxic Factors by Human Peripheral Blood Mononuclear Cells","volume":"49","author":"Yousefi S.","year":"1989","journal-title":"Cancer Research"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.4103\/idoj.IDOJ_142_18"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.4103\/JCAS.JCAS_170_20"},{"issue":"4","key":"e_1_2_12_53_1","article-title":"Comparative Efficacy and Safety of Intralesional MMR Vaccine Versus Vitamin D3 for Multiple Warts: A Prospective Study","volume":"15","author":"Ahmed S.","year":"2024","journal-title":"Journal of Cardiovascular Disease Research"}],"container-title":["Journal of Cosmetic Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocd.70618","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jocd.70618","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocd.70618","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T04:14:43Z","timestamp":1769228083000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jocd.70618"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":52,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/jocd.70618"],"URL":"https:\/\/doi.org\/10.1111\/jocd.70618","archive":["Portico"],"relation":{},"ISSN":["1473-2130","1473-2165"],"issn-type":[{"value":"1473-2130","type":"print"},{"value":"1473-2165","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-10-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70618"}}