Severe cutaneous reactions to phenytoin.

Kp, Dawson

doi:10.1136/adc.48.3.239

Cited by 4 publications

(1 citation statement)

References 7 publications

(5 reference statements)

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“…A skin reaction to phenytoin has been reported in about 50% of epileptic children' 2 14 ; it seems to be more common in children' 71" than in adults.3 A mild maculopapular erythema or erythema multiforme is typically described, but serious reactions of Stevens-Johnson type have also been reported.6 7 16-18 The prevalence of serious or fatal reactions among reported cases undoubtedly overemphasises the serious exanthem, while the actual prevalence of a mild to moderate rash is underestimated, possibly because patients do not report the rashes to their doctors.…”

Section: Discussionmentioning

confidence: 99%

High incidence of a concentration-dependent skin reaction in children treated with phenytoin.

Wilson¹,

Höjer²,

Tomson³

et al. 1978

BMJ

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1583thyroid-hormone pool. Much emphasis has been placed on the role of the circulating thyroid-hormone binding proteins in regulating the peripheral turnover of thyroid hormones, and the importance of cellular factors has not been adequately stressed. Probably the effect of anticonvulsants on TBG binding is a relatively minor one in patients receiving these drugs. The normal results of the thyroid-hormone binding test indicate that there is no decrease in residual binding sites on TBG, which may result from the occupancy of some sites by the anticonvulsants, a reduction in TBG concentration, or a combination of these factors.Our detailed analysis of the effects of individual anticonvulsants indicates that phenytoin significantly depresses TT4, FT4, and FT3 concentrations. The other two drugs had no main effects, but with 35 of the 42 patients receiving phenytoin this finding may merely reflect a lack of sufficient data to detect the effects.Dr P P B Yeo was supported by the Nuffield Foundation, and this work forms part of a dissertation to be submitted to the University of Singapore for the degree of MD. Medical_ouirnial, 1978Medical_ouirnial, , 1, 1583Medical_ouirnial, -1586 Summary and conclusions A particularly high incidence of rash was seen in children with epilepsy treated with phenytoin. Ten children with untreated epilepsy were therefore included in a prospective study and given either 3 (group 1) or 6 (group 2) mg of phenytoin/kg body weight/day for five days followed by 6 mg/kg body weight/day for both groups. Four of the five children in group 2 compared with only one of the five in group 1 developed a rash seven to 12 days after the start of treatment. Patients with rashes had significantly higher plasma phenytoin concentrations. Whenever the phenytoin concentration was higher than 14 stmol/l on day 5 a rash occurred.These findings indicate that the generalised skin reaction is caused by a high body burden of phenytoin, which results from either a high load of the drug or a low clearance rate.

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Section: Discussionmentioning

confidence: 99%

High incidence of a concentration-dependent skin reaction in children treated with phenytoin.

Wilson¹,

Höjer²,

Tomson³

et al. 1978

BMJ

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Mucocutaneous eruptions due to antiepileptic drug therapy in children

Pollack¹,

Burk²,

Nathanson³

1979

Annals of Neurology

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Three children with bullous erythema multiforme and 1 with toxic epidermal necrolysis associated with antiepileptic drug therapy are described. One patient is unique because of seven mucocutaneous eruptions caused by three classes of antiepileptic drugs. Lymphocyte stimulation by antiepileptic drugs could not be demonstrated in the 2 patients in whom appropriate studies were performed, and no precipitating antibodies to antiepileptic drugs were found. Observation of four diagnostic and therapeutic principles, which are illustrated by the course of our patients, may reduce the incidence of life-threatening mucocutaneous eruptions and simplify the long-term management of individuals in whom such reactions occur.

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Dilantin digital defects

Johnson

Goldsmith²

1981

Journal of the American Academy of Dermatology

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Severe cutaneous reactions to phenytoin.

Cited by 4 publications

References 7 publications

High incidence of a concentration-dependent skin reaction in children treated with phenytoin.

High incidence of a concentration-dependent skin reaction in children treated with phenytoin.

Mucocutaneous eruptions due to antiepileptic drug therapy in children

Dilantin digital defects

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