TOPICAL PHENYTOIN VERSUS EUSOL IN THE TREATMENT OF NON-MALIGNANG CHRONIC LEG ULCERS

Abstract

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: Surgical wards,Muhimbili National Hospital from August 2000 to September
2001.
Patients: one hundred and two (102) 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).50 formed the study group and 52 controls. the age range
was 15-56 years ;the majority in 27-31 years 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 enrollment, 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 7 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 14th day (p<0.01).Clearance of ulcer
discharge was also significant in the phenytoin group on the 7th and 14th day of
treatment(<0.05). The commonest bacteria isolated were pseudomonas aeuriginosa(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 14th
and 21st 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 resourcescarce
environments.