Burns

Mendiola-Gonzalez, Espejo-Plascencia, Chapa-Alvarez and Rodriguez-Noriega, Investigacion Medica Internacional (1983),2788 reported the topical use of PHT powder in the treatment of second-degree burns. The study included eighty patients. Forty, given conventional treatment, were used as controls. Twenty were treated with topical PHT, ten with oral PHT, and ten with a combination of topical and oral PHT.  

In the control group, the average time to healing or grafting was thirty days. In the oral PHT group, it was twenty-three days. In the topical group and the combined treatment group, the time to healing or grafting was sixteen days.

Topical PHT resulted in rapid elimination of pain at the burn site. Biopsy of the PHT-treated burns showed increased collagen, decreased inflammation, and more capillaries compared to controls. Bacterial burn-surface cultures in the PHT groups became negative after five to ten days of treatment. The bacterial cultures remained positive in the conventional treatment group, until healing or grafting.

2788. Mendiola-Gonzalez, J. F., Espejo-Plascencia, I., Chapa-Alvarez, J. R., Rodriguez-Noriega, E. Sodium diphenylhydantoin in burns: effects of pain and healing, Invest. Med. Int., 10: 443-7,1983.

Lodha, Journal of Burn Care and Rehabilitation (1991), 3320 conducted a controlled clinical trial of topical phenytoin therapy for second- and third-degree burns (15% to 50% of total body surface). For each of the fifty patients, two burn surfaces (a total of 100 sites) similar in area and severity were evaluated. One burn surface on each patient was dressed with either 1% silver sulfadiazine cream or with topical phenytoin powder applied as a thin layer. Each wound was dressed with dry, sterile gauze, changed every other day or as required, until the lesion healed or was grafted. For the PHT-treated group, the percentage reduction of second-degree burn areas was consistently greater. On the tenth day the burn area was reduced by 55.3% 14.8% (mean SD), compared to 32.5% 8.7% with silver sulfadiazine. At twenty days, the reduction was 89.6% 9.9% for the PHT group, compared with 56.9% 16.5% for the silver sulfadiazine group (p < 0.001). In large, deep burns (100 to 150 cm2), separation of slough and appearance of granulation tissue were observed ten to fifteen days earlier in the PHT-treated group, and most such wounds were ready for grafting by the end of the second week. Grafting was successful for all PHT-treated sites, as compared to only 70% of the sites treated with silver sulfadiazine. PHT decreased burn-wound fluid loss, induced early separation of slough and promoted rapid burn surface healing. It was noted that the PHT-treated patients appeared more comfortable and had less pain.

3320. Lodha, S.C., New application of an old drug: topical phenytoin in burns, J. Burn Care Rehabil., 12(1): 96, 1991.

Bajaj, Nayar and Bhandari, Personal Communication, Burn Unit, Lohia Hospital, New Delhi, India (1994), 3321 reported on two studies concerning the beneficial topical effects of PHT. One study focused on PHT's effect on hypertrophic scarring and the other study looked at burn wounds. In the first study, skin grafts were taken from both of patients' thighs or legs (in order to study the topical effect of Dilantin on hypertrophic scarring exactly equal depth of injury was necessary). PHT was applied to one thigh or leg and the other was treated as a control. The mean healing time was assessed by when the topical dressing became loose or after two weeks when donor site dressings were uncovered. In a follow-up study spanning over 7 years, results indicated that hypertrophy in two patients in both groups showed the hypertrophy to be due to an inherent tendency in the skin and to not be related to either group. This led to the conclusion that PHT does not lead to hypertrophic scarring when applied locally.

The other study concentrated on the use of topical PHT on burns. A total of 1011 patients were studied of whom 500 received topical PHT treatment (experimental group) and 511 received conventional silver sulphadiazene cream (SSD) application, a common anti-bacterial cream used for burns (control group). Despite PHT not having any known antibacterial property it gave comparable results as the SSD application against Pseudomonas and other bacteria. In addition, the immunoglobulin levels in both groups were comparable. This suggests that the application of PHT increased the rate of burn healing and could modulate the activity of the cells at the local level, thereby making cells less prone to bacterial invasion. This may be due to the ability of PHT to produce reduced cell irritability in burns. The theory was confirmed by evidence of a reduction in seepage of fluid from the burn area and a comparatively decreased amount of intravenous fluid required during the shock period.

3321. Bajaj, S.P., Nayar, R., and Bhandari, P.S., Topical use of phenytoin in the management of acute burns, Personal Communication, 1994.

Kang, National Workshop of Clinical Use of Phenytoin, Chengdu, China (1995), 3322 applied phenytoin powder locally to treat 20 patients with second-degree burns and residual burn wounds. The results were compared to those observed in a control group of 20 patients. For the phenytoin treated patients the mean healing time was 16.7 days while for the patients in the control group the time was 21 days. In addition to promoting burn wound healing, the authors report that phenytoin was more effective in relieving pain and decreasing the number of positive bacterial cultures.

3322. Kang, S., Clinical observation of phenytoin in burn treatment, Presented at the National Workshop of Clinical Use of Phenytoin, Chengdu, China, 1995.

Pu, Tang, Jiang, Li and Cheng, National Workshop of Clinical Use of Phenytoin, Chengdu, China (1995), 3323 conducted a clinical study of treatment of burn (second-degree) wounds with zinc phenytoin compared to sodium phenytoin and silver sulfadiazine. The drugs, as a 1% ointment, were applied with a daily dressing change. Ten patients were treated with zinc phenytoin, eight patients with sodium phenytoin, and nine with silver sulfadiazine. For those patients receiving zinc phenytoin, the time of healing of the wound surface was 11 2.7 days, and for those patients receiving sodium phenytoin, the time of healing was 14 3.1 days. The wounds treated with silver sulfadiazine healed in 11 3.8 days. The bacterial growth, exudation, swelling, inflammation and the formation of hyperplastic scar were compared. Based on their results, the authors conclude that zinc phenytoin was the most effective of the three treatments.

3323. Pu, Q., Tang, X., Jiang, F., Li, B., and Cheng, F., Clinical study of zinc phenytoin in the treatment of burn wounds, Presented at the National Workshop of Clinical Use of Phenytoin, Chengdu, China, 1995.

Carneiro, Rwanyuma and Mkony, Central African Medical Journal (2002), 3324 conducted a prospective, randomized, controlled study of the effectiveness of a fourteen-day course of topical phenytoin, compared to that of Silverex (silver sulfadiazine plus chlorhexidine), in sixty-four patients (thirty-three males and thirty-one females, 68.7% being children under five) with small-to-moderate-size (up to 30% of body surface) burns in Tanzania from July 2000 to February 2002. Hot liquids (79.7%) and open flames (20.3%) were the causes of the burn injuries. Fifty percent of the burn injuries involved the trunk. Just over 50% of the patients had burn wounds involving less than 15% of their body surface.

After days 5 and 10 of treatment, more patients in the phenytoin group had negative wound cultures than those in the control group (p < .006 and p < .001 respectively). Purulent discharge and foul smell were also less with phenytoin. More than 78% of patients appeared more comfortable and had less pain with phenytoin, compared to 46.9% of those on Silverex (p < .01). At day 14, more than 90% of the burns in the PHT group were healed, compared to 75.6% with Silverex. Although this seemed to represent a trend toward faster healing with phenytoin, the difference was not statistically significant. Only one patient in the PHT group required change to a different therapy, whereas seven patients with Silverex had to be switched to alternative treatments. The authors conclude that phenytoin is useful in the treatment of small-to- moderate size second-degree burn wounds. Its low cost is a major advantage.

3324. Carneiro, P.M.R., Rwanyuma, L.R.J., and Mkony, C.A., A comparison of topical phenytoin with silverex in the treatment of superficial dermal burn wounds, Cent. Afr. J. Med., 48(9/10): 105-8, 2002.

See also Ref.

3325. Lohiya, M.L., Effect of dilantin sodium in surgical practice with special reference to abscess cavities and burn lesions, Doctoral Thesis, University of Rajasthan, Jaipur, India, 1988.

3326. Rwehumbiza, L. and Rwanyuma, J., A comparison of topical diphenylhydantoin with a standard therapy in burn wounds at Muhimbili National Hospital, Dar es Saalam, Tanzania, Doctoral Thesis, 2001.

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