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Topical phenytoin for treating pressure ulcers.

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The effectiveness of topical phenytoin for healing pressure ulcers remains uncertain. More high-quality research is needed to determine its benefits and potential harms in treating these common clinical issues.

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Area of Science:

  • Dermatology
  • Wound Care
  • Pharmacology

Background:

  • Pressure ulcers are a significant global health concern, leading to patient suffering and increased healthcare costs.
  • Various treatments exist, including dressings, ointments, and creams, with phenytoin showing potential for accelerating healing.
  • Phenytoin, typically used for epilepsy, is being investigated for its topical application in wound management.

Purpose of the Study:

  • To evaluate the efficacy of topical phenytoin in accelerating the healing rate of pressure ulcers across all grades.
  • To compare the effects of topical phenytoin against placebo or alternative treatments in diverse clinical settings.

Main Methods:

  • A systematic search of multiple electronic databases (Cochrane Wounds, CENTRAL, MEDLINE, Embase, CINAHL) was conducted in September 2016.
  • Randomized clinical trials (RCTs) comparing topical phenytoin with placebo, alternative treatments, or no therapy were included, with no restrictions on language, date, or setting.
  • Data extraction and risk of bias assessment were performed independently by two reviewers using Cochrane methodology, with evidence quality rated by GRADE.

Main Results:

  • Three small RCTs with 148 participants (grades I and II pressure ulcers) met the inclusion criteria.
  • Low-quality evidence suggests hydrocolloid dressings may be more effective than topical phenytoin for ulcer healing (71.4% vs. 39.3% healed).
  • Evidence is insufficient to determine if topical phenytoin improves healing compared to simple dressings, with high risk of bias and limited data in included studies.

Conclusions:

  • Current evidence is insufficient to confirm whether topical phenytoin enhances the healing of grade I and II pressure ulcers.
  • No adverse events were reported in the included trials, though minimal pain was noted in one study.
  • Further large-scale, rigorous RCTs are required to ascertain the true efficacy, safety, quality of life impact, and cost-effectiveness of topical phenytoin for pressure ulcer treatment.