Skin changes in epilepsy

Aims To establish the skin changes found in epileptics, and to relate these changes to drug therapy. Background Skin changes in epileptics, although welt acknowledged, have been subjected to few recent large-scale surveys. Newer anti-epileptic drugs, in addition to the older therapies, including phenytoin, phenobarbitone and primidone, are now popular. In an effort to update our knowledge of skin changes in epileptics, a study of 200 patients in a long-term epilepsy hospital was performed. Methods The study included taking a history, recording drug therapy and examining the skin of 200 patients. Results Patients ranged in age from 21 to over 70. 60% were men and 40% women. Their epilepsy was mostly well controlled, varying in length from less than 10 to greater than 40 years. 57.5% had post traumatic scars. 32.5% had gum hypertrophy, only half having dental caries. Dupuytren's contracture occurred in 24.5%. Seborrheic dermatitis was seen in 15%. 12.5% had coarse facial features and 11.5% had acne. 57.5% of women had facial hirsutes. 17.5% of all patients had sacral hirsutes, which is an unique feature in this group of patients. These clinical findings were correlated with drugs taken at the time, the age of the patients and length of epilepsy. 52% were on carbamazepine, 48% on phenytoin and 42% on primidone or phenobarbitone, singly or in combination. Conclusions A number of skin conditions are more common among epileptics. Phenytoin and phenobarbitone are linked to gingival hypertrophy, palmar fibromatosis, hypertrichosis, coarse fades and acne. Carbamazepine, too, may be implicated in gum hypertrophy, palmar fibromatosis, hypertrichosis, more specifically sacral hirsutes, seborrheic dermatitis, acne and coarse facies.