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Topical phenytoin versus EUSOL in the treatment of non-malignant chronic leg ulcers.

Abstract

OBJECTIVE

To compare topical diphenylhydantoin (phenytoin) with Edinburgh University solution of lime (EUSOL) in terms of rate of ulcer healing, analgesic and antibacterial properties in non-malignant chronic leg ulcers.

DESIGN

A prospective randomized controlled study.

SETTING

Muhimbili National Hospital surgical wards from August 2000 to September 2001.

PATIENTS

One hundred and two patients with non-malignant chronic leg ulcers of various aetiologies, 50 in the study (phenytoin)group and 52 in the control(EUSOL) group.

INTERVENTIONS

Study group studied by sprinkling phenytoin powder and the control group with EUSOL, in both groups the ulcers were addressed daily and followed up for 28 days or until they epithelialised or were ready for skin grafting. The data collected included demographic characteristics of patients, aetiology of the ulcers, pus discharge, severity of pain due to the ulcers, bacterial cultures from ulcer swabs, rate of reduction in mean ulcer surface area and outcome of treatment.

RESULTS

The study enrolled 67 male and 35 female patients over a 14 month period (August to September 2001). Fifty patients formed the study group and 52 formed the controls. The age range was 12-56 years; the majority being in the 27-31 year age group. Major causes of chronic leg ulcers were those infected following trauma (27.5%), chronic non-specific inflammations (21.6%) and infected burn wounds (15.7%). At enrolment, the duration of ulcers ranged from 3-156 weeks and 3-128 weeks in the phenytoin and control groups respectively. Overall, there was significant reduction in pain(p < 0.05) on day seven in the phenytoin group. Furthermore in patients who presented with severe pain, there was a significant reduction in pain in the phenytoin group on the fourteenth day (p < 0.01). Clearance of ulcer discharge was also significant in the phenytoin group on the seventh and fourteenth day of treatment(p < 0.05). The commonest bacteria isolated were pseudomonas aeruginosa (54.9%) and staphylococcus aureus (10.8%). However, bacterial colonization clearance was not statistically significant when the two groups were compared. The rate of formation of healthy granulation tissue was highly significant in the phenytoin group by the fourteenth and twenty first days of treatment (p < 0.001). The phenytoin group showed significant reduction in the mean ulcer surface area on days 7, 14, 21 and 28 (p < 0.05). Chronic ulcers due to animal bites healed fastest followed by those due to trauma.

CONCLUSION

Phenytoin powder is cheap and easily applied topically on ulcers, effectively relieves pain, clears discharge and enhances formation of granulation tissue thereby promoting healing; reducing morbidity and financial burden enabling its use in resource-poor environments.

Authors+Show Affiliations

,

Department of Surgery, Faculty of Medicine, Muhimbili University College of Health Sciences, P.O. Box 65451, Dar es Salaam, Tanzania.

Source

East African medical journal 80:3 2003 Mar pg 124-9

MeSH

Administration, Topical
Adult
Anti-Bacterial Agents
Borates
Chronic Disease
Colony Count, Microbial
Exudates and Transudates
Female
Humans
Leg Ulcer
Male
Pain Measurement
Phenytoin
Prospective Studies
Pseudomonas aeruginosa
Sodium Hypochlorite
Staphylococcus aureus
Time
Treatment Outcome
Wound Healing

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12762426

Citation

Carneiro, P M R., and E T M. Nyawawa. "Topical Phenytoin Versus EUSOL in the Treatment of Non-malignant Chronic Leg Ulcers." East African Medical Journal, vol. 80, no. 3, 2003, pp. 124-9.
Carneiro PM, Nyawawa ET. Topical phenytoin versus EUSOL in the treatment of non-malignant chronic leg ulcers. East Afr Med J. 2003;80(3):124-9.
Carneiro, P. M., & Nyawawa, E. T. (2003). Topical phenytoin versus EUSOL in the treatment of non-malignant chronic leg ulcers. East African Medical Journal, 80(3), pp. 124-9.
Carneiro PM, Nyawawa ET. Topical Phenytoin Versus EUSOL in the Treatment of Non-malignant Chronic Leg Ulcers. East Afr Med J. 2003;80(3):124-9. PubMed PMID: 12762426.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Topical phenytoin versus EUSOL in the treatment of non-malignant chronic leg ulcers. AU - Carneiro,P M R, AU - Nyawawa,E T M, PY - 2003/5/24/pubmed PY - 2003/7/2/medline PY - 2003/5/24/entrez SP - 124 EP - 9 JF - East African medical journal JO - East Afr Med J VL - 80 IS - 3 N2 - OBJECTIVE: To compare topical diphenylhydantoin (phenytoin) with Edinburgh University solution of lime (EUSOL) in terms of rate of ulcer healing, analgesic and antibacterial properties in non-malignant chronic leg ulcers. DESIGN: A prospective randomized controlled study. SETTING: Muhimbili National Hospital surgical wards from August 2000 to September 2001. PATIENTS: One hundred and two patients with non-malignant chronic leg ulcers of various aetiologies, 50 in the study (phenytoin)group and 52 in the control(EUSOL) group. INTERVENTIONS: Study group studied by sprinkling phenytoin powder and the control group with EUSOL, in both groups the ulcers were addressed daily and followed up for 28 days or until they epithelialised or were ready for skin grafting. The data collected included demographic characteristics of patients, aetiology of the ulcers, pus discharge, severity of pain due to the ulcers, bacterial cultures from ulcer swabs, rate of reduction in mean ulcer surface area and outcome of treatment. RESULTS: The study enrolled 67 male and 35 female patients over a 14 month period (August to September 2001). Fifty patients formed the study group and 52 formed the controls. The age range was 12-56 years; the majority being in the 27-31 year age group. Major causes of chronic leg ulcers were those infected following trauma (27.5%), chronic non-specific inflammations (21.6%) and infected burn wounds (15.7%). At enrolment, the duration of ulcers ranged from 3-156 weeks and 3-128 weeks in the phenytoin and control groups respectively. Overall, there was significant reduction in pain(p < 0.05) on day seven in the phenytoin group. Furthermore in patients who presented with severe pain, there was a significant reduction in pain in the phenytoin group on the fourteenth day (p < 0.01). Clearance of ulcer discharge was also significant in the phenytoin group on the seventh and fourteenth day of treatment(p < 0.05). The commonest bacteria isolated were pseudomonas aeruginosa (54.9%) and staphylococcus aureus (10.8%). However, bacterial colonization clearance was not statistically significant when the two groups were compared. The rate of formation of healthy granulation tissue was highly significant in the phenytoin group by the fourteenth and twenty first days of treatment (p < 0.001). The phenytoin group showed significant reduction in the mean ulcer surface area on days 7, 14, 21 and 28 (p < 0.05). Chronic ulcers due to animal bites healed fastest followed by those due to trauma. CONCLUSION: Phenytoin powder is cheap and easily applied topically on ulcers, effectively relieves pain, clears discharge and enhances formation of granulation tissue thereby promoting healing; reducing morbidity and financial burden enabling its use in resource-poor environments. SN - 0012-835X UR - https://www.unboundmedicine.com/medline/citation/12762426/Topical_phenytoin_versus_EUSOL_in_the_treatment_of_non_malignant_chronic_leg_ulcers_ L2 - https://medlineplus.gov/antibiotics.html DB - PRIME DP - Unbound Medicine ER -