Role of phenytoin in wound healing - A wound pharmacology perspective

Topical agents used for the enhancement of wound healing are designed to ac t locally and, therefore, do not undergo classic systemic metabolic modific ation. This commentary reviews the potential role of a vulnerary agent, phe nytoin (PHT), from a wound pharmacology perspective. This agent may have th e potential to alter the dynamics of wound healing, suggesting a therapeuti c use for the stimulation of chronic wounds. Oral PHT therapy is used widel y for the: treatment of convulsive disorders, and about half the patients t reated develop gingival overgrowth as a side-effect. This apparent stimulat ory effect has prompted its assessment in wound healing. Investigations int o the mechanisms of gingival overgrowth also provide clues to its action in wound healing, and important similarities and differences are discussed. I t arrears also that both gingiva and skin are important extrahepatic sites for xenobiotic metabolism, and analysis of the biochemical mechanisms shoul d lead to the design of safer analogues for wound healing. On die other han d, differences between the pharmacokinetics of topical PHT in these tissue situations indicate that different formulations are required for gingival a nd cutaneous wound healing and during the changing course of wound healing itself. (C) 1999 Elsevier Science Inc.