Scleroderma

Morgan, Cutis (1971),1371 reports that patients with scleroderma, treated with PHT, showed marked improvement when compared with patients treated by conventional therapy.

The study consisted of sixty-five patients with two general types of scleroderma, morphea and systemic. Twenty-nine were treated with PHT and thirty-six were treated by conventional means.

The attention of the author was brought to the use of PHT in scleroderma in an unusual way. A sixty-seven-year-old woman had progressive generalized morphea. For over a year, a wide variety of medications had been tried and failed to halt progression of the disease. Then the patient had a mild stroke and was placed on PHT by her neurologists. Progressive improvement in scleroderma was evident three weeks after she began PHT. Two years later her skin showed no evidence of scleroderma and has remained clear to date.

Because of the unexpected improvement in this case, the author decided to explore the possibility that PHT might be effective in the treatment of scleroderma. In his study the author used PHT in twenty-nine patients and conventional therapy in thirty-six patients. The results follow:

 

With PHT

Other Therapy

Number Of Patients

29

36

Worse

0

11

No Change

2

10

Improved (patient and Doctor Agree)

12

9

Complete clearing of sclerosis

12

4

Complete clearing of sclerosis, atrophy and pigment

3

2

 

The author concludes that in this series of patients with scleroderma, the administration of PHT appeared not only to prevent progression of sclerosis but also to aid in its resolution. (In a smaller group of patients, the author also investigated the use of PHT in a less serious disorder, lichen sclerosis et atrophicus, and found PHT as effective as conventional therapy.)

1371. Morgan, R. J., Scleroderma: treatment with diphenylhydantoin, Cutis, 8: 278-282, 1971.

Jayaraman, Ilangovan, Abdul Razack and Muthuswami, 18th National Conference of the Indian Association of Dermatologists, Venereologists and Leprologists, Jaipur, India (1990), 3327 in a trial of PHT (dose 2-5 mg/kg) for 20 patients with localized scleroderma, found moderate response in 3 patients, good response in 6 patients, very good in 9 and no response in 2. The two patients who did not respond had linear morphea. Seven of the patients who showed good to very good response had previously failed to respond for many years to other treatments.

3327. Jayaraman, M., Ilangovan, G., Abdul Razack, A., and Muthuswami, T.C., Diphenylhydantoin in localized scleroderma, Presented at the 18th National Conference of the Indian Association of Dermatologists, Venereologists and Leprologists, SMS Medical College & Hospital, Jaipur, India, 1990.

Liu and Song, National Workshop of Clinical Use of Phenytoin, Chengdu, China (1995), 3328 used phenytoin to treat 30 cases of scleroderma, confirmed by clinical and histopathological examination. The scleroderma was localized for 27 patients, systemic for 2 and of the extremity with systemic lupus erythematosus for one patient. Most of the lesions were distributed on the limbs and some were located on the face and trunk. The duration of the disease ranged from 2 - 20 years. A daily dose of 100 - 200 mg of phenytoin was given (those patients under 14 years old received a dose of 100 mg/day). After 3 to 6 months treatment, 5 patients were cured, 7 patients showed remarkable effect, and 16 patients achieved some positive effect. For 2 patients, the treatment had no effect. While three patients had side effects, the authors reported that no patient had a serious toxic reaction.

3328. Liu, B. and Song, X., The effect of phenytoin on scleroderma, Presented at the National Workshop of Clinical Use of Phenytoin, Chengdu, China, 1995.

Eubanks, McBurney, Galen and Reed, International Journal of Dermatology (1996), 3329 in a review of linear scleroderma in children notes that a consistently effective therapy has not been found. Based on the results of Neldner (1978), the authors recommend that PHT should be fully evaluated in formal clinical trials.

3329. Eubanks, L.E., McBurney, E.I., Galen, W., and Reed, R., Linear scleroderma in children, Int. J. Dermatol., 35(5):330-6, 1996.

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