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Year : 2014  |  Volume : 15  |  Issue : 2  |  Page : 103-104

Phenytoin induced coarse facies, gum hypertrophy and hirsutism in a female child


Department of Pediatrics, JSS Medical College, JSS University, Mysore, Karnataka, India

Date of Web Publication27-Aug-2014

Correspondence Address:
K Jagadish Kumar
Department of Pediatrics, JSS Medical College, JSS University, Mysore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.139518

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How to cite this article:
Kumar K J, Prasad N A, Patil S, Vikash V M. Phenytoin induced coarse facies, gum hypertrophy and hirsutism in a female child. Indian J Paediatr Dermatol 2014;15:103-4

How to cite this URL:
Kumar K J, Prasad N A, Patil S, Vikash V M. Phenytoin induced coarse facies, gum hypertrophy and hirsutism in a female child. Indian J Paediatr Dermatol [serial online] 2014 [cited 2019 Dec 14];15:103-4. Available from: http://www.ijpd.in/text.asp?2014/15/2/103/139518

Sir,

A 9 year cerebral palsy girl was on phenytoin since 3 years of age. She is not on regular follow-up. At present follow-up, she was on phenytoin 7 mg/kg/day. On examination coarse facies, gum hypertrophy and hirsutism was present [Figure 1]. She was seizure free and blood counts, liver function tests, kidney function test, blood sugar and serum calcium were normal. When the seizures began, a computed tomography scan of the brain showed dilatation of the ventricles. The prevalence of phenytoin-induced gingival overgrowth is 15-50%. [1],[2],[3] Debate is ongoing regarding whether drug-induced gingival overgrowth is due to hyperplasia of the gingival epithelium or of submucosal connective tissue and/or both. Risk factors known to contribute include the presence of gingival inflammation resulting from poor oral hygiene. Furthermore, the presence of dental plaque may provide a reservoir for the accumulation of phenytoin. [1] In a study by Thomason et al. showed a significant correlation between plaque score and gingival overgrowth in the phenytoin-treated patient; however, there was no correlation between gingival overgrowth and salivary concentration of the drug. [3] Phenytoin has been shown to induce gingival overgrowth by its interaction with a subpopulation of sensitive fibroblasts. Phenytoin also increases the serum concentration of basic fibroblast growth factor, 3 fold and has correlated with gum hyperplasia. [1] Morbidity can be because of gross overgrowth of gingival tissue, which can lead to gingival bleeding, pain, teeth displacement and periodontal disease. Hirsutism occurs in 8-12% of children receiving phenytoin. [4] It occurs on the extensor surfaces of the extremities, on the trunk and face. In children cosmetic effects of gingival hyperplasia and hair aggravates after chronic phenytoin therapy.
Figure 1: Phenytoin induced coarse facies, gum hypertrophy and hirsutism

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  References Top

1.Mejia LM, Lozada-Nur F. Drug induced gingival hyperplasia. E medicine, 2009;article/1076264. Available from: http://www.Medscope.com. [Last accessed on 2013 Aug 01].  Back to cited text no. 1
    
2.Thiagarajan B, Ramamoorthy G. Drug induced gingival overgrowth. Webmed Otorhinolaryngology 2012;3:WMC003829.  Back to cited text no. 2
    
3.Thomason JM, Seymour RA, Rawlins MD. Incidence and severity of phenytoin-induced gingival overgrowth in epileptic patients in general medical practice. Community Dent Oral Epidemiol 1992;20:288-91.  Back to cited text no. 3
    
4.Kepler KE. Alopesia, hirustim and hypertrichosis. In: Tisdale JE, Miller DA, editors. Drug-Induced Diseases: Prevention, Detection and Management. Sect. 2. 2 nd ed. Bethesda: American Society of Health System Pharmacists; 2010. p. 158-74.  Back to cited text no. 4
    


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