Dermatologic Manifestations of Peyronie Disease
- Author: Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD; Chief Editor: Dirk M Elston, MD more...
In 1587, Guilio Cesare Aranzi was the first to formally describe Peyronie disease (PD) in his book Tumores praeter naturam. He called Peyronie disease "a rare affection of the genitals in people with excessive sexual intercourse: a little penile tumor palpable like a bean in the flaccid penis causing a deformity similar to a ram horn during erection." The disease was not given its current name until 1743, when Francoise de La Peyronie described the cases of 3 men with fibrous thickening of the penile shaft, painful erections, and penile curvature, as demonstrated in the images below.
Medscape Reference's Urology article, Peyronie Disease, also may be helpful.
Although the exact etiology of Peyronie disease is not clear, trauma may cause perivascular inflammation. In ordinary tissue, the rupture of blood vessels leads to coagulation and fibrin deposition. Fibrinolysis of the deposited fibrin occurs as tissue cells proliferate to close the site of injury. In Peyronie disease, the tunica albuginea may initially undergo microvascular trauma during sexual intercourse. Adequate postinjury fibrinolysis is prevented because the tunica albuginea is hypovascular.
After multiple microvascular traumas, large quantities of fibrin accumulate in the form of a plaque, generally along the dorsal and ventral midline aspects of the penile shaft. This deposition appears to be immune mediated. Some people may be genetically predisposed to this reaction. The plaque prevents the adequate expansion of the tissue during erection, leading to penile curvature and pain. The relationship of this condition to other fibromatoses suggests a predisposition to fibrous proliferation. Although these microtraumatic events are implicated in the current theory of the pathogenesis of Peyronie disease, no etiology is proven.
Results of animal studies indicate that transforming growth factor-beta (TGF-beta) may be involved in the formation of the plaques via early inflammatory reactions. When TGF-beta analogs are injected into rat tunica albuginea, they form collagen bundles that are morphologically similar to those in Peyronie disease.
Peyronie disease starts in 1 of 2 ways. Most patients report the acute onset of pain accompanied by a lump in the shaft of the penis, followed by gradually increasing curvature with or without pain. Alternatively, a minority of the patients report curvature of the penile shaft that occurs suddenly, seemingly overnight, and remains stable once it occurs.
In the progressive form, the cycle of trauma, fibrin deposition, and attempts at fibrinolysis continue to escalate. Remodeling of the fibrin deposits can take as long as 2 years in the absence of further traumatic events.
The rate for Peyronie disease is 0.3-4% among white men.
Peyronie disease is less common in men of African or Asian heritage.
Peyronie disease is well documented in whites. Peyronie disease may occur in black men, often in the presence of preexisting diabetes mellitus and erectile dysfunction.
Peyronie disease predominantly occurs in men aged 40-60 years. The age range of affected persons is 30-80 years.
Devine CJ Jr, Somers KD, Jordan SG, Schlossberg SM. Proposal: trauma as the cause of the Peyronie's lesion. J Urol. 1997 Jan. 157(1):285-90. [Medline].
Casabé A, Bechara A, Cheliz G, De Bonis W, Rey H. Risk factors of Peyronie's disease. What does our clinical experience show?. J Sex Med. 2011 Feb. 8(2):518-23. [Medline].
Lucattelli M, Lunghi B, Fineschi S, et al. A new mouse model of Peyronie's disease: an increased expression of hypoxia-inducible factor-1 target genes during the development of penile changes. Int J Biochem Cell Biol. 2008. 40(11):2638-48. [Medline].
Nachtsheim DA, Rearden A. Peyronie's disease is associated with an HLA class II antigen, HLA-DQ5, implying an autoimmune etiology. J Urol. 1996 Oct. 156(4):1330-4. [Medline].
Nyberg LM Jr, Bias WB, Hochberg MC, Walsh PC. Identification of an inherited form of Peyronie's disease with autosomal dominant inheritance and association with Dupuytren's contracture and histocompatibility B7 cross-reacting antigens. J Urol. 1982 Jul. 128(1):48-51. [Medline].
Gualdieri L, Valentini G, Lupoli S, Giordano M. Peyronie's disease in systemic sclerosis. Report of two cases. J Rheumatol. 1988 Feb. 15(2):380-1. [Medline].
Stewart S, Malto M, Sandberg L, Colburn KK. Increased serum levels of anti-elastin antibodies in patients with Peyronie's disease. J Urol. 1994 Jul. 152(1):105-6. [Medline].
Hricak H, Marotti M, Gilbert TJ, et al. Normal penile anatomy and abnormal penile conditions: evaluation with MR imaging. Radiology. 1988 Dec. 169(3):683-90. [Medline].
Erdogru T, Boz A, Koksal T, et al. Penile scintigraphy with 99mTc-human immunoglobulin G: a novel method for distinguishing the unstable and stable phases of Peyronie's disease. BJU Int. 2002 Nov. 90(7):703-6. [Medline].
Waldhauser M, Schr. P. Efficiency and side effects of prostaglandin E1 in the treatment of erectile dysfunction. J Urol. 1988 Sep. 140(3):525-7. [Medline].
Gelbard M, Goldstein I, Hellstrom WJ, McMahon CG, Smith T, Tursi J, et al. Clinical efficacy, safety and tolerability of collagenase clostridium histolyticum for the treatment of peyronie disease in 2 large double-blind, randomized, placebo controlled phase 3 studies. J Urol. 2013 Jul. 190(1):199-207. [Medline].
Safarinejad MR, Asgari MA, Hosseini SY, Dadkhah F. A double-blind placebo-controlled study of the efficacy and safety of pentoxifylline in early chronic Peyronie's disease. BJU Int. 2009 Oct 26. [Medline].
Biagiotti G, Cavallini G. Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report. BJU Int. 2001 Jul. 88(1):63-7. [Medline].
Di Stasi SM, Giannantoni A, Stephen RL, et al. A prospective, randomized study using transdermal electromotive administration of verapamil and dexamethasone for Peyronie's disease. J Urol. 2004 Apr. 171(4):1605-8. [Medline].
Levine LA, Merrick PF, Lee RC. Intralesional verapamil injection for the treatment of Peyronie's disease. J Urol. 1994 Jun. 151(6):1522-4. [Medline].
Levine LA, Goldman KE, Greenfield JM. Experience with intraplaque injection of verapamil for Peyronie's disease. J Urol. 2002 Aug. 168(2):621-5; discussion 625-6. [Medline].
Ahuja S, Bivalacqua TJ, Case J, Vincent M, Sikka SC, Hellstrom WJ. A pilot study demonstrating clinical benefit from intralesional interferon alpha 2B in the treatment of Peyronie's disease. J Androl. 1999 Jul-Aug. 20(4):444-8. [Medline].
Dang G, Matern R, Bivalacqua TJ, Sikka S, Hellstrom WJ. Intralesional interferon-alpha-2B injections for the treatment of Peyronie's disease. South Med J. 2004 Jan. 97(1):42-6. [Medline].
Polat O, Gul O, Ozbey I, Ozdikici M, Bayraktar Y. Peyronie's disease: intralesional treatment with interferon alpha-2A and evaluation of the results by magnetic resonance imaging. Int Urol Nephrol. 1997. 29(4):465-71. [Medline].
Montorsi F, Salonia A, Guazzoni G, et al. Transdermal electromotive multi-drug administration for Peyronie's disease: preliminary results. J Androl. 2000 Jan-Feb. 21(1):85-90. [Medline].
Morgan RJ, Pryor JP. Procarbazine (Natulan) in the treatment of Peyronie's disease. Br J Urol. 1978 Apr. 50(2):111-3. [Medline].
Oosterlinck W, Renders G. Treatment of Peyronie's disease with procarbazine. Br J Urol. 1975 Apr. 47(2):219-20. [Medline].
Hauck EW, Altinkilic BM, Ludwig M, et al. Extracorporal shock wave therapy in the treatment of Peyronie's disease. First results of a case-controlled approach. Eur Urol. 2000 Dec. 38(6):663-9;discussion 670. [Medline].
Husain J, Lynn NN, Jones DK, Collins GN, O'Reilly PH. Extracorporeal shock wave therapy in the management of Peyronie's disease: initial experience. BJU Int. 2000 Sep. 86(4):466-8. [Medline].
Incrocci L, Hop WC, Seegenschmiedt HM. Radiotherapy for Peyronie's Disease: a European survey. Acta Oncol. 2008. 47(6):1110-2. [Medline].
Furlow WL, Swenson HE Jr, Lee RE. Peyronie's disease: a study of its natural history and treatment with orthovoltage radiotherapy. J Urol. 1975 Jul. 114(1):69-71. [Medline].
Yafi FA, Pinsky MR, Stewart C, Sangkum P, Ates E, Trost LW, et al. The Effect of Duration of Penile Traction Therapy in Patients Undergoing Intralesional Injection Therapy for Peyronie's Disease. J Urol. 2015 Sep. 194 (3):754-8. [Medline].
Abern MR, Larsen S, Levine LA. Combination of penile traction, intralesional verapamil, and oral therapies for Peyronie's disease. J Sex Med. 2012 Jan. 9 (1):288-95. [Medline].
[Guideline] Nehra A, Alterowitz R, Culkin DJ, Faraday MM, Hakim LS, Heidelbaugh JJ, et al. Peyronie's Disease: AUA Guideline. J Urol. 2015 Sep. 194 (3):745-53. [Medline].
Trussell JC, Brien JC. Straightening out Peyronie's: a medical and surgical approach to the patient. Can J Urol. 2008 Jun. 15(3):4047-55. [Medline].
Devine CJ Jr, Horton CE. Surgical treatment of Peyronie's disease with a dermal graff. J Urol. 1974 Jan. 111(1):44-9. [Medline].
Gangai MP, Rivera LR, Spence CR. Peyronie's plaque: excision and graft versus incision and stent. J Urol. 1982 Jan. 127(1):55-6. [Medline].
Wild RM, Devine CJ Jr, Horton CE. Dermal graft repair of Peyronie's disease: survey of 50 patients. J Urol. 1979 Jan. 121(1):47-50. [Medline].
Imbeault A, Bernard G, Ouellet G, Bouhout S, Carrier S, Bolduc S. Surgical option for the correction of Peyronie's disease: an autologous tissue-engineered endothelialized graft. J Sex Med. 2011 Nov. 8(11):3227-35. [Medline].
Knoll LD, Furlow WL, Benson RC Jr. Management of Peyronie disease by implantation of inflatable penile prosthesis. Urology. 1990 Nov. 36(5):406-9. [Medline].
Yafi FA, Sangkum P, McCaslin IR, Hellstrom WJ. Strategies for penile prosthesis placement in Peyronie's disease and corporal fibrosis. Curr Urol Rep. 2015 Apr. 16 (4):21. [Medline].
Fournier GR Jr, Lue TF, Tanagho EA. Peyronie's plaque: surgical treatment with the carbon dioxide laser and a deep dorsal vein patch graft. J Urol. 1993 May. 149(5 Pt 2):1321-5. [Medline].
Zarafonetis CJ, Horrax TM. Treatment of Peyronie's disease with potassium para-aminobenzoate (potaba). J Urol. 1959 Jun. 81(6):770-2. [Medline].
Akkus E, Carrier S, Rehman J, Breza J, Kadioglu A, Lue TF. Is colchicine effective in Peyronie's disease? A pilot study. Urology. 1994 Aug. 44(2):291-5. [Medline].
Ralph DJ, Brooks MD, Bottazzo GF, Pryor JP. The treatment of Peyronie's disease with tamoxifen. Br J Urol. 1992 Dec. 70(6):648-51. [Medline].