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Dilantin

Phenytoin sodium (marketed as Dilantin® in the USA and as Epanutin® in the UK, by Parke-Davis, now part of Pfizer) is a commonly used antiepileptic. It was approved by the Food and Drug Administration in 1953 for use in seizures. Phenytoin acts to damp the unwanted, runaway brain activity seen in seizure by reducing electrical conductance among brain cells. more...

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History

Phenytoin (diphenylhydantoin) was first synthesized by a German physician named Heinrich Biltz in 1908. Biltz sold his discovery to Parke-Davis, which did not find an immediate use for it. In 1938, outside scientists including H. Houston Merritt and Tracy Putnam discovered phenytoin's usefulness for controlling seizures, without the sedation effects associated with phenobarbital. There are some indications that phenytoin has other effects, including anxiety control and mood stabilization, although it has never been approved for those purposes by the FDA.

Jack Dreyfus, founder of the Dreyfus Fund, became a major proponent of phenytoin as a means to control nervousness and depression when he received a prescription for Dilantin in 1966. Dreyfus' book about his experience with phenytoin, A Remarkable Medicine Has Been Overlooked, sits on the shelves of many physicians courtesy of the work of his foundation. Despite more than $70 million in personal financing, his push to see phenytoin evaluated for alternative uses has had little lasting effect on the medical community. This was partially due to Parke-Davis's reluctance to invest in a drug nearing the end of its patent life, and partially due to mixed results from various studies.

Dilantin made an appearance in the 1962 novel One Flew Over the Cuckoo's Nest by Ken Kesey, both as an anticonvulsant and as a mechanism to control inmate behavior.

Side-effects

At therapeutic doses, phenytoin produces horizontal gaze nystagmus, which is harmless but occasionally tested for by law enforcement as a marker for drunkenness (which can also produce nystagmus). At toxic doses, patients experience sedation, cerebellar ataxia, and ophthalmoparesis, as well as paradoxical seizures. Idiosyncratic side effects of phenytoin, as with other anticonvulsants, include rash and severe allergic reactions.

There is some evidence that phenytoin is teratogenic, causing what Smith and Jones in their Recognizable Patterns of Human Malformation called the fetal hydantoin syndrome. There is some evidence against this. One blinded trial asked physicians to separate photographs of children into two piles based on whether they showed the so-called characteristic features of this syndrome; it found that physicians were no better at diagnosing the syndrome than would be expected by random chance, calling the very existence of the syndrome into question. Data now being collected by the Epilepsy and Antiepileptic Drug Pregnancy Registry may one day answer this question definitively.

Phenytoin may accumulate in the cerebral cortex over long periods of time, as well as causing atrophy of the cerebellum when administered at chronically high levels. Despite this, the drug has a long history of safe use, making it one of the more popular anti-convulsants prescribed by doctors, and a common "first line of defense" in seizure cases. Phenytoin may also cause gingival hyperplasia.

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Simple steps to flawless skin; basic lifestyle changes make the difference when it comes to achieving a clear complexion
From Shape, 10/1/04 by Doris Day

We've all heard how important it is to care for our skin from the outside--but what's often not recognized is just how much our lifestyle affects the appearance of our skin, particularly when it comes to acne. Yes, cleansing regularly, applying the right treatment products and developing better skin habits (e.g., avoiding picking at all costs) will help keep your complexion clear, but it's only when you target skin from both the outside and the inside that you'll begin to see longer-lasting results. Eating the right foods, exercising consistently and making time for daily stress relief are just a few of the good-for-you habits beneficial for your skin, but there are others. Here, what you need to do now to improve the appearance of your skin and, in the process, your overall health.

plenty of sleep

Since the skin's repair processes are hard at work while you slumber (you need seven to nine hours a night), being sleep-deprived can actually worsen the look of your skin by intensifying dark circles and/or puffiness under the eyes. Sleep deprivation also can lead to increased breakouts (or slow the healing of ones you already have).

While it's easier said than done, there are things you can do before bed to maximize the overnight skin-renewal process and help your skin look its best come morning. First and foremost, always remove makeup before bed since it's that very makeup, plus the dirt and grime that collect on skin during the day, that increases a pore's likelihood of getting clogged. If you're too exhausted to do a thorough removal, convenient pre-moistened cleansing cloths, such as Noxzema Wet Cleansing Cloths ($4; at drugstores), can quickly--and easily--get the job done.

regular exercise

The revitalizing and energizing benefits of exercise (and the circulation boost it provides the entire body) are certainly good for your overall well-being--not to mention the healthy glow it gives your skin. But some women notice just the opposite effect: an increase in breakouts following exercise. What's important to know: Such breakouts aren't caused by exercise itself, but by how you treat your skin before, during and after your workout. Here's how to treat your skin right.

Remove makeup before exercising. Unless the makeup you're wearing specifically states that it contains anti-pimple ingredients like salicylic acid and is oil-free and noncomedogenic (meaning it won't clog pores), remove it before working out, since it's likely to block your pores once you start sweating. Some makeup best bets include Almay Clear Complexion Blemish Healing Makeup ($12; at drugstores), Neutrogena SkinClearing Oil-Free Concealer ($8; at drugstores) and Good Skin Sheer Color Makeup and/or Sheer Color Finishing Powder ($14 and $13; goodskindermcare.com and at Kohl's stores nationwide).

Wear appropriate workout clothing. A combination of factors, such as more heat and sweat generated during exercise, can lead to overactive sebaceous glands (the oil-producing glands in the skin). When combined with bacteria, which often live at the base of the hair follicles, this increased production of sebum can contribute to breakouts. Wearing moisture-wicking synthetic fabrics that draw sweat away from the skin and allow heat to escape can be a significant help.

Bathe immediately after your workout. Cleanse your body with an exfoliating wash that contains the poredeclogging ingredient salicylic acid. But don't overscrub; this can irritate skin and even worsen your acne. Best product bets include Murad Acne Body Wash ($35; www.murad.com) and Good Skin All Right Medicated Cleanser ($12; goodskindermcare.com and at Kohl's stores nationwide).

stress relief

While stress doesn't cause acne, it can make it worse. One reason: When we're under pressure, we tend to let our good habits lapse. For instance, we crave foods higher in fat and sugar; we sleep less or poorly; we react to situations more emotionally and get angry more easily--all thanks to the hormone, cortisol, that's released during times of tension. Since cortisol itself can trigger acne by causing inflammation, neglecting good habits creates a double whammy for our complexion.

Find stress-relief techniques that really work for you. You don't have to spend hours practicing stress-management techniques or meditating or doing yoga every day (all proven ways to reduce stress) if none of those appeals to you. Instead, find a way to relax that fits into your daily schedule, so it becomes something you'll do regularly. One simple idea: Take a slow, deep breath in through your nose, hold it for four seconds and then slowly breathe out through your mouth. As you exhale, feel your whole body relax. Another easy technique: Mentally walk yourself through an upcoming event you perceive will be stressful--visualize yourself being confident and relaxed, and when it happens for real, chances are that you will be. Finally, taking just a 10-minute walk outdoors can clear your mind enough to allow cortisol levels to drop. The key is to find a technique you like--and stick with it.

a balanced diet

There are many myths about what causes acne. Chocolate and greasy foods often get the blame, but it remains unclear exactly what effect they (and other foods) have on breakouts. One thing is certain, however: Eating a balanced diet rich in fresh fruits and vegetables--detailed in the tips below--is the best way to stay healthy and have clear skin.

Get your nutrients. A healthy diet is rich in minerals and vitamins, particularly vitamins A, C and E, which are critical for smooth, clear skin. Vitamin A Topically and internally, this vitamin family (often labeled as retinols in over-the-counter products) is used in various forms to treat acne and clear up skin. It helps to speed up skin-cell turnover, giving cells less time to clog pores and trigger acne. Nutritionally, vitamin A is found in foods like broccoli, cantaloupe, cod, red peppers, spinach and watercress. The recommended dietary allowance is 700 micrograms.

Vitamin C This vitamin (also found in topical products) helps boost production of the skin-firming tissue collagen and defends against free radicals (highly reactive oxygen molecules--triggered by environmental factors like pollution, the sun's ultraviolet rays and cigarette smoke--that damage the skin's DNA). Foods rich in vitamin C include citrus fruits, strawberries and tomatoes. The recommended dietary allowance is 75 milligrams.

Vitamin E Tocopherol, the most active form of vitamin E, is also a free-radical scavenger (topically and internally), and it helps keep cell membranes stable and strong, minimizing the inflammation that is a prominent component of acne. Find vitamin E in foods like almonds, wheat germ and avocados. The recommended dietary allowance is 15 milligrams.

Stay hydrated. Consume the equivalent of at least 11 8-ounce glasses daily (that's counting all fluid intake from beverages and food). Water is essential for life, and drinking it is important for every organ system, including the skin (it makes it more supple and resilient). Besides thirst, signs of dehydration include fatigue and loss of skin tone (the skin sags more and loses its glow).

Eat chocolate and greasy foods in moderation. Stressful situations that make greasy or fatty foods like chocolate, french fries and potato chips harder to resist also may be responsible for acne flare-ups, many experts believe. But if you're convinced that a certain food is worsening your acne, the best thing to do is avoid that food for a few weeks--while continuing a topical course of treatment (either over-the-counter or prescription, depending on the severity of your acne)--to see if there's improvement.

Limit your intake of iodine-rich foods/medications. One substance in foods that can make acne worse is iodine, if consumed in large-enough quantities. Foods high in iodine include kelp and seafood like shrimp and other shellfish. However, it's unlikely you eat enough of these foods to cause or worsen breakouts. (Eating shellfish for most of your meals would, however, be a problem.) But what's typically not known is that certain medications (including lithium and anti-seizure medications like Dilantin) can contain iodine in quantities sufficient to trigger acne. If you're on medication and have experienced acne flare-ups, ask your dermatologist about a possible link.