LYCOS RETRIEVER 
Phenytoin: Patients
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Phenytoin can induce porphyria. In one patient, phenytoin increased skin pigmentation and hirsutism, decreased serum IgA level, and apparently unmasked hereditary coproporphyria.[125] It can ... unmask acute intermittent porphyria. [126] Acute intermittent porphyria has occurred in patients on phentoin therapy with normal erythrocyte porphobilinogen deaminase activity.[127] Phenytoin also can affect the development of porphyria cutanea tarda.[128] It has also led to the development of unclassified porphyria.[129] It can be part of the multifactorial development of porphyria.[130]
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Phenytoin and other hydantoins are contraindicated in patients who have experienced phenytoin hypersensitivity. Additionally, caution should be exercised if using structurally similar compounds (eg, barbiturates, succinimides, oxazolidinediones and other related compounds) in these same patients.
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Phenytoin appears more effective in the treatment of other epidermolysis bullosa variants. It has been used to treat junctional epidermolysis bullosa.[16, 17] In one case, it reduced blister formation by 50 percent after two months of treatment (2 mg/kg increased to 15 mg/kg/day with a serum level of 12-15µg/ml). The disease flared 1 week after discontinuance.[18] Another study found it effective in treating two patients with generalized atrophic benign EB (GABEB) and ineffective in treating two patients with Herlitz disease.[19] Others have found it ineffective for treating junctional epidermolysis bullosa.[20] It has been used to treat the Dowling-Meara variant of epidermolysis bullosa simplex.[21] Topical phenytoin (2 %-5 % cream twice daily) has been found helpful in treating the ulcers of epidermolysis bullosa simplex.[22]
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