Phenytoin in the Treatment of Epidermolysis Bullosa

Abstract

Objective: To review the efficacy of phenytoin in the treatment of epidermolysis bullosa (EB). Data Sources: English-language clinical study reports, abstracts, case reports, and review articles pertaining to the use of phenytoin in the treatment of EB (MEDLINE search, January 1973-August 1996). Data Extraction: Clinical study and case reports evaluating the effect of phenytoin in the treatment of EB were reviewed, and the methodology, results, and conclusions of the studies were evaluated. Because of the limited number of randomized, controlled study reports, all available case reports were reviewed, and information we considered pertinent was synthesized. Data Synthesis: Results of studies of EB suggest that the blister fluid and fibroblasts in patients with this disease produce an increased amount of collagenase, which is thought to induce blistering. Phenytoin inhibits collagenase synthesis and/or secretion and, therefore, is used to treat patients with EB. Data regarding the use of phenytoin in patients with EB, especially those with recessive dystrophic EB, revealed that phenytoin may reduce the number of blisters in these patients. Dosage recommendations and monitoring parameters are also discussed. Conclusions: More randomized, controlled trials are needed to determine the true efficacy of phenytoin in the treatment of EB. Although the only available report of a randomized, controlled trial reported a lack of phenytoin efficacy in patients with EB, it does not rule out the possibility of success in selected patients.