FROM SEIZURES TO WOUNDS: THE POTENTIAL OF PHENYTOIN IN TRAUMATIC WOUND MANAGEMENT

PASUPULETI ARCHANA BABU; A. CHANDRA SEKHAR; VISHNU

doi:10.22159/ijpps.2023v15i6.48079

Authors

PASUPULETI ARCHANA BABU Government General Hospital, Budhwarpet Road, Kurnool-518002, Andhra Pradesh, India
A. CHANDRA SEKHAR Kurnool Medical College, Bharath Petroleum, Near, Bhudawarapet, Kisan Ghat Road, Kurnool-518002, Andhra Pradesh, India
VISHNU Kurnool Medical College, Bharath Petroleum, Near, Bhudawarapet, Kisan Ghat Road, Kurnool-518002, Andhra Pradesh, India

DOI:

https://doi.org/10.22159/ijpps.2023v15i6.48079

Keywords:

Phenytoin, Wound healing, Traumatic wound, Granulation tissue, Saline dressing

Abstract

Objective: Phenytoin is a medication primarily used to treat seizures, but it has been discovered to have the potential for wound healing due to its ability to increase collagen production, promote new blood vessel growth, reduce inflammation, fight infections, and encourage new skin growth. These effects are particularly useful for healing chronic wounds like pressure ulcers, diabetic ulcers, traumatic wounds, and venous ulcers.

Methods: This is a two-year prospective study conducted between January 2020 and December 2022 at the Government General Hospital in Kurnool. A study was conducted on 60 patients with traumatic wounds, dividing them into two groups. One group received topical phenytoin dressing, while the other received normal saline dressing. The study compared wound surface area, granulation tissue percentage, pain ratings on the visual analog scale, and healing time between the groups on day 14 and day 21.

Results: On day 0, cases and controls had similar wound surface areas (62.17±25.74 cm2 and 62.14±21.57 cm2, respectively) and VAS scores (8.81±1.22 and 8.88±1.52). By day 14, cases had significantly smaller wound surface areas (41±32.32 cm2), a higher percentage of granulation tissue (75.56±7.30%), and lower VAS scores (4.57±1.78) compared to controls (53.28±25.33 cm2, 58.45±7.01%, and 6.32±1.02, respectively). By day 21, cases had even smaller wound surface areas (28.3±31.75 cm2), a higher percentage of granulation tissue (93±3.46%), and lower VAS scores (2.78±0.42) compared to controls (40.34±34.23 cm2, 72.56±5.05%, and 4.82±1.27, respectively). The time for wound healing was significantly shorter for cases (22.76±7.28 d) compared to controls (32.64±9.31 d). On day 21, negative cultures were found in 80% of wounds in the study group and 50% of wounds in the control group, with a statistically significant difference (P-value<0.05).

Conclusion: Topical phenytoin dressing had positive effects on wound healing by increasing the rate of granulation tissue formation, providing better pain relief, and shortening the healing time. It was found to be a safe, effective, and cost-effective option for wound healing due to its various mechanisms. The study highlights the significance of phenytoin in treating traumatic wounds, particularly in patients with limited access to expensive wound-healing medications.

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References

Wigton HA. Dilantin in the treatment of epilepsy. Nebr State Med J. 1947 Jul;32(7):272. PMID 20246690.

Shapiro M. Acceleration of gingival wound healing in non-epileptic patients receiving diphenylhydantoin sodium (Dilantin, epanutin). Exp Med Surg. 1958;16(1):41-53. PMID 13537920.

Jayalal JA, Kumar SJ, Dhinesh TD, Kadar JM. The efficiency of topical phenytoin on healing in diabetic foot ulcer: a randomized controlled trial. Int J Sci Stud. 2015 Jun;3(3):84-9.

Ahmed A, Ahmed MI. A comparison of the efficacy of topical use of phenytoin and Vaseline gauze dressing with Vaseline gauze dressing alone in the healing of diabetic foot ulcers. J Postgrad Med Inst. 2014;28(3):297-302.

Rhodes RS, Heyneman CA, Culbertson VL, Wilson SE, Phatak HM. Topical phenytoin treatment of stage II decubitus ulcers in the elderly. Ann Pharmacother. 2001 Jun;35(6):675-81. doi: 10.1345/aph.10267, PMID 11408983.

Bhatia A, Nanda S, Gupta U, Gupta S, Reddy BS. Topical phenytoin suspension and normal saline in the treatment of leprosy trophic ulcers: a randomized, double-blind, comparative study. J Dermatolog Treat. 2004 Sep;15(5):321-7. doi: 10.1080/09546630410018085, PMID 15370401.

Modaghegh S, Salehian B, Tavassoli M, Djamshidi A, Rezai AS. Use of phenytoin in healing of war and non-war wounds. A pilot study of 25 cases. Int J Dermatol. 1989;28(5):347-50. doi: 10.1111/j.1365-4362.1989.tb01363.x, PMID 2666326.

Pendse AK, Sharma A, Sodani A, Hada S. Topical phenytoin in wound healing. Int J Dermatol. 1993 Mar;32(3):214-7. doi: 10.1111/j.1365-4362.1993.tb02799.x. PMID 8444538.

DaCosta ML, Regan MC, Al Sader M, Leader M, Bouchier Hayes D. Diphenylhydantoin sodium promotes early and marked angiogenesis and results in increased collagen deposition and tensile strength in healing wounds. Surgery. 1998 Mar;123(3):287-93. doi: 10.1016/S0039-6060(98)70181-3, PMID 9526520.

Kato T, Okahashi N, Kawai S, Kato T, Inaba H, Morisaki I. Impaired degradation of matrix collagen in human gingival fibroblasts by the antiepileptic drug phenytoin. J Periodontol. 2005 Jun;76(6):941-50. doi: 10.1902/jop.2005.76.6.941, PMID 15948689.

Shakeri F, Tebyanian H, Karami A, Babavalian H, Tahmasbi MH. Effect of topical phenytoin on wound healing. Trauma Mon. 2017 Sep;e35488. doi: 10.5812/traumamon.35488, PMID 29114460, PMCID PMC5661412.

Hasamnis A, Mohanty B, Muralikrishna, Patil S. Evaluation of wound healing effect of topical phenytoin on excisional wound in albino rats. J Young Pharm. 2010;2(1):59-62. doi: 10.4103/0975-1483.62215. PMID 21331193.

Swamy SM, Tan P, Zhu YZ, Lu J, Achuth HN, Moochhala S. Role of phenytoin in wound healing: microarray analysis of early transcriptional responses in human dermal fibroblasts. Biochem Biophys Res Commun. 2004 Feb 13;314(3):661-6. doi: 10.1016/j.bbrc.2003.12.146. PMID 14741686.

Hollisaz MT, Khedmat H, Yari F. A randomized clinical trial comparing hydrocolloid, phenytoin and simple dressings for the treatment of pressure ulcers [ISRCTN33429693]. BMC Dermatol. 2004 Dec 15;4(1):18. doi: 10.1186/1471-5945-4-18, PMID 15601464, PMCID PMC545970.

Hasamnis A, Mohanty B, Muralikrishna, Patil S. Evaluation of wound healing effect of topical phenytoin on excisional wound in albino rats. J Young Pharm. 2010;2(1):59-62. doi: 10.4103/0975-1483.62215. PMID 21331193.

El Zayat SG. Preliminary experience with topical phenytoin in wound healing in a war zone. Mil Med. 1989 Apr;154(4):178-80. doi: 10.1093/milmed/154.4.178, PMID 2499825.

Muthukumarasamy MG, Sivakumar G, Manoharan G. Topical phenytoin in diabetic foot ulcers. Diabetes Care. 1991 Oct;14(10):909-11. doi: 10.2337/diacare.14.10.909, PMID 1773690.

Pendsey SP. Understanding diabetic foot. Int J Diabetes Dev Ctries. 2010 Apr;30(2):75-9. doi: 10.4103/0973-3930.62596, PMID 20535310, PMCID PMC2878694.

Carneiro PM, Nyawawa ET. Topical phenytoin versus EUSOL in the treatment of non-malignant chronic leg ulcers. East Afr Med J. 2003 Mar;80(3):124-9. doi: 10.4314/eamj.v80i3.8680. PMID 12762426.

Lodha SC, Lohiya ML, Vyas MC, Bhandari S, Goyal RR, Harsh MK. Role of phenytoin in healing of large abscess cavities. Br J Surg. 1991 Jan;78(1):105-8. doi: 10.1002/bjs.1800780132, PMID 1998849.

Meena K, Mohan AV, Sharath B, Somayaji SN, Bairy KL. Effect of topical phenytoin on burn wound healing in rats. Indian J Exp Biol. 2011 Jan;49(1):56-9. PMID 21365997.

Carneiro PM, Rwanyuma LR, Mkony CA. A comparison of topical phenytoin with silverex in the treatment of superficial dermal burn wounds. Cent Afr J Med. 2002 Sep-Oct;48(9-10):105-8. PMID 14562531.

Tauro LF, Shetty P, Dsouza NT, Mohammd S, Sucharitha S. A comparative study of the efficacy of topical phenytoin vs conventional wound care in diabetic ulcers. Int J Med Med Sci. 2013;3:8-16.

Kodela SR, Kumar TJP, Vivek D. Outcome of topical phenytoin in the management of diabetic ulcers. IOSR JDMS. 2016 Jul;15(7):39-54. doi: 10.9790/0853-1507123954.

Anstead GM, Hart LM, Sunahara JF, Liter ME. Phenytoin in wound healing. Ann Pharmacother. 1996 Jul-Aug;30(7-8):768-75. doi: 10.1177/106002809603000712, PMID 8826558.

Bhatia A, Prakash S. Topical phenytoin for wound healing. Dermatol Online J. 2004 Jul 15;10(1):5. doi: 10.5070/D30Z3612W1, PMID 15347487.