Comparative Efficacy and Safety of Intralesional MMR Vaccine and Vitamin D3 in Managing Nongenital Warts: A Systematic Review and Meta‐Analysis

BACKGROUND: Cutaneous warts are common benign lesions caused by human papillomavirus and often resist conventional treatments. Intralesional immunotherapy with measles-mumps-rubella (MMR) vaccine or vitamin D3 has emerged as an alternative, but their comparative efficacy and safety remain unclear. METHODS: We conducted a systematic review and meta-analysis 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. RESULTS: = 0%), recurrence (RR 2.20; 95% CI 0.73-6.58; p = 0.16), or pain (RR 0.92; 95% CI 0.74-1.14; p = 0.46). Vitamin D3 was linked to more swelling (RR 2.79; 95% CI 1.15-6.75; p = 0.02), while MMR was associated with more erythema (RR 0.60; 95% CI 0.42-0.86; p = 0.006). CONCLUSIONS: 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.