Comparative evaluation of topical phenytoin versus povidone iodine dressing in the healing of diabetic foot ulcers: a randomized controlled trial
DOI:
https://doi.org/10.18203/2349-2902.isj20253448Keywords:
Diabetic foot ulcer, Phenytoin, Povidone iodine, Wound healingAbstract
Background: Diabetic foot ulcers (DFUs) are a crucial diabetes consequence that frequently leads to slow healing, infection and the need for amputation. Povidone iodine (PVP-I) is a widely used antiseptic, whereas phenytoin has lately emerged as a promising wound healing agent due to its proliferative and antibacterial effects. Hence the current study aims to compare the efficacy of topical phenytoin and povidone iodine dressings in promoting healing of diabetic foot ulcers.
Methods: A randomized controlled trial was conducted at Navodaya Medical College Hospital, Raichur among 124 patients with grade 1 or 2 diabetic foot ulcers were randomly assigned to two groups which are Group A (phenytoin dressing) and Group B (povidone iodine dressing). Ulcer area was measured at baseline and on Days 3, 5, 7, 10 and 14. Percentage reduction in ulcer area, slough clearance and granulation tissue formation was measured and subjected to statistical analysis.
Results: Both groups showed significant reduction in ulcer area by Day 14, with greater improvement in Group A (22.03±9.86%) than in Group B (13.85±5.62%) (p=0.001). Mean absolute reduction in ulcer area was higher in the phenytoin group (6.03 mm² vs. 3.99 mm², p=0.004). Slough clearance was achieved in 95.2% of patients in Group A versus 82.3% in Group B. Granulation tissue appeared earlier and was more robust in Group A. No significant adverse effects were reported.
Conclusions: Topical phenytoin dressing is significantly more effective than povidone iodine in accelerating up the healing of diabetic foot ulcers.
Metrics
References
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(1):81-90. DOI: https://doi.org/10.2337/dc14-S081
Sushko K, Strachan P, Butt M, Nerenberg KA, Sherifali D. Understanding the self-management experiences and support needs during pregnancy among women with pre-existing diabetes: a qualitative descriptive study. BMC Preg Child. 2023;23(1):309. DOI: https://doi.org/10.1186/s12884-023-05542-4
Parveen K, Hussain MA, Anwar S, Elagib HM, Kausar MA. Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management. World J Diabetes. 2025;16(3):100329. DOI: https://doi.org/10.4239/wjd.v16.i3.100329
Sandhu DK, Singh DK, Banga DR, Sandhu DK, Samria DJ. Role of topical phenytoin (Diphenylhydantoin) dressing in diabetic ulcers: A comparative study with conventional dressing. Int J Orthop. Sci. 2018;4:239-42. DOI: https://doi.org/10.22271/ortho.2018.v4.i1d.35
Bharadva PB, Choksi DB, Damor S, Shah J. Topical phenytoin dressing versus conventional dressing in diabetic ulcers. Int Surg J. 2017;22;4(5):1682. DOI: https://doi.org/10.18203/2349-2902.isj20171621
Karri Y, Yerra P, Tulasi AS. Phenytoin In Wound Healing: Exploring Its Efficacy In Specific Wound Types. Int J Acad Med Pharm. 2025;7(3):65-71.
Vardhan A, Garg P, Sehgal VK, Naidu C, Bankar M, Mittal S. Efficacy of topical phenytoin in healing diabetic foot ulcer. Int J Basic Clin Pharmacol. 2016;5(6):2645-8. DOI: https://doi.org/10.18203/2319-2003.ijbcp20164139
Adana P, Dayal A, Patel N. Effectiveness of topical phenytoin versus normal saline dressing in the management of diabetic foot ulcers: a non‐randomized interventional study. Res J Med Sci. 2025;19:214-20. DOI: https://doi.org/10.36478/makrjms.2025.2.214.220
Nather A, Fang TT. Diabetic foot wounds-types of wounds and classification systems. surgery for diabetic foot. A Pract Oper Manual. 2016;13:1. DOI: https://doi.org/10.1142/9789814759847_0001
Mohsin F, Javaid S, Tariq M, Mustafa M. Molecular immunological mechanisms of impaired wound healing in diabetic foot ulcers (DFU), current therapeutic strategies and future directions. Int Immunopharmacol. 2024;139:112713. DOI: https://doi.org/10.1016/j.intimp.2024.112713
Banu AS, Ganesan S. Evaluating the efficacy of topical phenytoin in the healing of neuropathic diabetic foot ulcers: a comparative study. Cureus. 2024;16(6):63282.
Fattahi N, Abdolahi A, Vahabzadeh Z, Nikkhoo B, Manoochehri F, Goudarzzadeh S, et al. Topical phenytoin administration accelerates the healing of acetic acid-induced colitis in rats: evaluation of transforming growth factor-beta, platelet-derived growth factor and vascular endothelial growth factor. Inflammopharmacology. 2022;30(1):283-290. DOI: https://doi.org/10.1007/s10787-021-00885-w
Sadiq KO, Shivakumar YM, Burra EK, Shahid K, Tamene YT, Mody SP, et al. Topical phenytoin improves wound healing with analgesic and antibacterial properties and minimal side effects: a systematic review. Wounds. 2024;36(2):50-60. DOI: https://doi.org/10.25270/wnds/23105
Rhodes R, Heyneman C, Culbertson V., et al. 2001. Topical Phenytoin Treatment of Stage II Decubitus Ulcers in the Elderly. Ann Pharmacother. 2001;35(6):675-81. DOI: https://doi.org/10.1345/aph.10267
El-Nahas M, Gawish H, Tarshoby M, State O. The impact of topical phenytoin on recalcitrant neuropathic diabetic foot ulceration. J Wound Care. 2009;18(1):33-7. DOI: https://doi.org/10.12968/jowc.2009.18.1.32146
Gunasekaran V, Subbaraj S, Aroul T. The efficacy of phenytoin dressing in healing of diabetic ulcer: a randomized control study. Int Surg J. 2017;4(10):3311-6. DOI: https://doi.org/10.18203/2349-2902.isj20174174
Zhang F, Chen Z, Su F, Zhang T. Comparison of topical honey and povidone iodine-based dressings for wound healing: a systematic review and meta-analysis. J Wound Care. 2021;30(4):28-36. DOI: https://doi.org/10.12968/jowc.2021.30.Sup4.S28
Paparao S, Redd KH. A study of efficacy of topical super oxidized solution in comparison with povidone iodine for the management of lower limb diabetic ulcers. Res J Pharm. 2025;19:7-11.
Downloads
Published
How to Cite
Issue
Section
