Introduction

Chronic ulcers and various other types of wounds pose a considerable economic, social, and public health challenge, which is increasingly significant as the population ages. Phenytoin plays an essential role in tissue repair, especially by promoting fibroblast proliferation and neovascularization. It has proven effective in the healing process of diabetic ulcers, traumatic injuries, chronic venous ulcers, and other non-healing chronic wounds.

Case Report

This was a study conducted in the Department of Plastic Surgery in a tertiary care center in South India. The patient was a 69 year old male with history of left diabetic foot with Charcot’s joint with a non-healing ulcer over the lateral aspect of left foot. Regenerative therapy was administered using phenytoin solution as follows:

Figure 1

A 2ml vial contains 100mg of Phenytoin

Figure 2

Application of phenytoin solution over the wound

Result

The topical application of phenytoin led to a notable improvement in wound healing.(Figure 1, Figure 2)

Discussion

In 1938, Meritt and Putnam published significant findings on the use of phenytoin for treating major seizures, absence seizures, and psychic equivalent seizures. The following year, Kimball and Horan made the first observation of gingival hyperplasia in some patients receiving phenytoin treatment. The earliest clinical trial, conducted in 1958, indicated that patients with surgical wounds who received oral phenytoin prior to surgery experienced reduced inflammation, less pain, and faster healing compared to those in the control group.1

Phenytoin was first launched as an antiseizure drug in 1937. For more than six decades, researchers have explored the potential of topical phenytoin for enhancing wound healing in various chronic wounds.

This stimulatory effect on connective tissue raises the intriguing possibility of using phenytoin in wound healing causing gum hypertrophy and thickening of skull and skin which raises the intriguing possibility of using phenytoin in wound healing.

Topical phenytoin sodium promotes wound healing through several mechanisms: it boosts fibroblast proliferation, inhibits collagenase activity, facilitates collagen deposition, enhances granulation tissue development, reduces bacterial contamination, minimizes wound exudate production, and increases the expression of growth factor receptors.2

DaCosta et al. found that phenytoin modifies the typical wound healing process and could be useful in clinical situations where inadequate collagen deposition contributes to poor healing, resulting in higher morbidity and mortality. Their study indicated increased fibroblast proliferation and neovascularization in phenytoin-treated wounds compared to controls at 3 days. By day 6, the inflammatory infiltrate in the treated wounds had nearly disappeared, but fibroblast infiltration and angiogenesis remained notably pronounced.3, 4

Conclusion

Due to its clear effectiveness in enhancing wound healing, along with its accessibility, affordability, user-friendliness, and safety, we highly advocate for the use of phenytoin in treating non healing ulcers. A larger prospective study is needed to confirm these findings.

Source of Funding

None.

Conflict of Interest

None.