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Podiatry : Wound Care
Wounds and pressure sores may heal more quickly if treated with topical phenytoin.
Medications which improve capillary blood flow can be added to a compounded
medication to enhance circulation at the wound margins and promote healing
of the injured area.
Topical Phenytoin for Wound Healing
The stimulatory effect of orally administered phenytoin on gingival tissue
prompted its assessment in wound healing. Phenytoin may promote wound healing
by a number of mechanisms, including stimulation of fibroblast proliferation,
facilitation of collagen deposition, glucocorticoid antagonism, and antibacterial
activity. Phenytoin has been used topically in the healing of pressure sores,
venous stasis and diabetic ulcers, traumatic wounds, skin autograft donor sites,
and burns.
Rhodes et al compared the healing of stage II decubitus ulcers with topically
applied phenytoin and two other standard topical treatment procedures in 47
patients in a long-term care setting. Ulcers were examined for the presence
of healthy granulation tissue, reduction in surface dimensions, and time to
healing. Topical phenytoin therapy resulted in a shorter time to complete healing
and formation of granulation tissue when compared with DuoDerm dressings or
triple antibiotic ointment applications. The mean time to healing in the phenytoin
group was 35.3 +/- 14.3 days compared with 51.8 +/- 19.6 and 53.8 +/- 8.5 days
for the DuoDerm and triple antibiotic ointment groups, respectively. Healthy
granulation tissue in the phenytoin group appeared within 2 to 7 days in all
subjects, compared to 6 to 21 days in the standard treatment groups. The phenytoin-treated
group showed no detectable serum phenytoin concentrations.
Anstead et al. described a patient with a massive grade IV pressure ulcer
that was unresponsive to conventional treatment, yet responded rapidly to treatment
with topical phenytoin. Song and Cheng reported phenytoin improved wound breaking
strength in normal and radiation-impaired wounds. The results of their study
indicated that topical phenytoin accelerated normal and irradiation-impaired
wound healing by increasing the number of wound macrophages and improving the
macrophage function. Pendse et al evaluated the effectiveness of topical phenytoin
in healing chronic skin ulcers in a controlled trial of 75 inpatients. At the
end of the fourth week, 29 of 40 phenytoin-treated ulcers had healed completely
versus 10 of 35 controls. They concluded: "topical phenytoin appears to
be an effective, inexpensive, and widely available therapeutic agent in wound
healing."
The effectiveness of topical phenytoin as a wound healing agent was compared
with that of OpSite and a conventional topical antibiotic dressing (Soframycin)
in a controlled study of 60 patients with partial-thickness skin autograft
donor sites on the lower extremities. Mean pain scores were lower and mean
time to complete healing (complete epithelialization) was best in the phenytoin-treated
group (6.2 +/- 1.6 days). Topical phenytoin compared very favorably with, and
in some aspects was superior to, occlusive dressings.
The efficacy of topical phenytoin in the treatment of diabetic foot ulcers
was evaluated in a controlled inpatient study. Fifty patients were treated
with topical phenytoin, and 50 patients received dry sterile occlusive dressings.
Both groups improved, but the ulcers treated with topical phenytoin healed
more rapidly. Mean time to complete healing was 21 days with phenytoin and
45 days with control.
No study reported any significant adverse effects secondary to topical phenytoin
therapy.
Ann Pharmacother 2001 Jun;35(6):675-81
Biochem Pharmacol 1999 May 15;57(10):1085-94
Ann Pharmacother 1996 Jul-Aug;30(7-8):768-75
Int J Dermatol 1993 Mar;32(3):214-7
Chung Hua I Hsueh Tsa Chih 1997 Jan;77(1):54-7
Burns 1993 Aug;19(4):306-10
Diabetes Care 1991 Oct;14(10):909-11
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