From seizures to Granulation Nation: The Unexpected Story of Phenytoin in Wound Healing

This episode traces how phenytoin — an anticonvulsant known for causing gingival overgrowth — was repurposed into a topical therapy for chronic wounds. It outlines the drug’s mechanisms in wounds: activating fibroblasts, increasing collagen synthesis, reducing MMP activity, modulating inflammation, and promoting granulation and angiogenesis in stalled diabetic foot ulcers. Listeners will hear clinical implications, common formulations, and important cautions: topical phenytoin can aid healing in selected chronic ulcers but does not replace debridement, offloading, vascular optimization, or infection control, and should be avoided in malignant wounds, untreated osteomyelitis, or critical ischemia. The episode also highlights the drug’s history and future delivery innovations.