Phenytoin

Phenytoin is an anticonvulsive drug that plays a pivotal role in the management of convulsive diseases. Because there is evidence for immunomodulating and anti-inflammatory activity of phenytoin, it was also considered a valuable alternative to treat LE. Accordingly, in one study, patients with DLE were treated with phenytoin for an average of 5 months, and cutaneous lesions were evaluated every 4 weeks (Rodriguez-Castellanos et al. 1995). Patients received 100mg of sodium diphenyl-hydantoin by mouth three times daily. In 9 of 10 patients with disseminated DLE, the response was reported to be excellent, and in 1 patient the response was considered to be very good (Callen 1982). Similar results were reported in another study demonstrating that 90% of patients (35 of 39 patients) with DLE significantly improved on treatment with phenytoin. Moreover, the remaining 4 patients (10%) also noted very good resolution of skin lesions. Toxicity was minimal in prevalence and severity. Within a follow-up period of 6-12 months, approximately 33% of patients remained without relapse, whereas approximately 16% relapsed. Follow-up data were not available in the remaining approximately 51% of the patients. Although, the exact mechanism of action of phenytoin in improving DLE is unclear, the promising clinical results may encourage further controlled clinical trials.

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