A Rare Association of Skin Adverse Reaction to Phenytoin

Phenytoin is a commonly used anticonvulsant drug in children and adults for tonic clonic and partial seizures with common side effects like nausea, stomach pain, loss of appetite, gum hypertrophy etc. We encountered a patient 34-year-old male who presented with history of one episode of convulsion, for which he was prescribed Tab Phenytoin 100mg twice daily by oral route. After 15 days he developed rash over trunk which spread to the whole body in two days associated with itching and scaling. There was no familial or personal history of drug allergy or skin conditions. Physical examination revealed multiple, purpuric macules and papules mainly on the trunk with scaling. Patient was admitted and subjected to investigations, which showed normal report. Tab Phenytoin was withdrawn and Tab Prednisolone 40mg orally daily was given and tapered by 10mg once in 15 days during which the lesions slowly showed improvement. Symptoms resolved completely in 2 weeks after phenytoin withdrawal and no adverse sequel reported. Thus the above case presentation exhibits a rare adverse effect of phenytoin on skin.