Is Topical Phenytoin Effective in Healing Diabetic Foot Ulcers in Patients Over Age 18?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not topical phenytoin is effective in healing diabetic foot ulcers in patients over age 18. STUDY DESIGN: Systematic review of three randomized controlled trials, published in 2011, 2013 and 2014. DATA SOURCES: Three randomized controlled trials comparing the effectiveness of topical phenytoin to placebo in healing diabetic foot ulcers. Data sources found using PubMed and Google Scholar. OUTCOMES MEASURED: Greater than 50% reduction in ulcer area measured via graph paper tracings and area reduction calculations, discontinuation of slough and discharge from ulcers via blind observer decision, complete wound closure measured via wound measurement with elliptical method and statement of closure or non-closure. RESULTS: In the study by Ahmed et al. (2014), 70% of patients treated with topical phenytoin experienced greater than 50% closure of their ulcers, compared to 43% of patients in the control group. Patil et al. (2013) found that 78% of ulcers treated with topical phenytoin stopped producing slough and discharge, compared to 16% of ulcers in the control group. Shaw et al. (2011) found that 62% of ulcers treated with a phenytoin dressing had complete wound closure, compared to 74% in the control-dressing group. CONCLUSIONS: There is conflicting evidence for whether topical phenytoin is effective in healing diabetic foot ulcers in patients over age 18. Two studies found significant evidence to support the efficacy of topical phenytoin in healing diabetic foot ulcers. One study did not find a significant difference in ulcer healing between patients treated with phenytoin and control dressings