A prospective study of the incidence of the purple glove syndrome.
OBJECTIVE
Phenytoin (PHT) has been widely used intravenously for the treatment of seizures since 1956, and for many years, it has been considered first-line therapy for status epilepticus. It is routinely administered intravenously in emergency departments and hospitals for patients who have had isolated seizures and for many patients undergoing neurosurgical procedures who are unable to receive oral medication. Adverse reactions from PHT have been widely studied for years, but in the past decade, new adverse reactions have been identified. One of these adverse reactions is the purple glove syndrome (PGS), characterized by edema, discoloration, and pain distal to the site of i.v. administration of PHT. Because there have been no prospective reports of the incidence of PGS, the objective of the study was to report the incidence of this syndrome.


METHODS
We enrolled 179 consecutive exposures to i.v. PHT at Henry Ford Hospital. Distal portions of the upper extremities were examined and digitally photographed by one of the authors (J.G.B.). The photos were blindly evaluated by the third author (G.L.B.) for PGS. Demographic and pertinent medical history was recorded for all patients, and outcome for those who experienced PGS was recorded. Associations between PGS, demographic, and medical history information were assessed.


RESULTS
In only three of the 179 exposures did PGS develop. In both patients, the severity of the clinical picture was mild and did not required prolonged hospitalization or specialized treatment.


CONCLUSIONS
PGS is an infrequent and mild adverse effect of i.v. PHT administration.
Burneo
J G
JG
Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA. jorgeburneo@netzero.net
Anandan
J V
JV
Barkley
G L
GL
D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004487:Edema / Q000139:chemically induced / Q000473:pathology; D004827:Epilepsy / Q000188:drug therapy / Q000517:prevention & control; D005260:Female; D005542:Forearm / Q000473:pathology; D006225:Hand / Q000473:pathology; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced / Q000473:pathology; D010672:Phenytoin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000139:chemically induced* / Q000453:epidemiology* / Q000473:pathology; D012880:Skin Pigmentation / Q000187:drug effects; D013577:Syndrome
D000927:Anticonvulsants; D010672:Phenytoin