Dermatologic Manifestations of Peyronie Disease Treatment & Management

  • Author: Jay W Zimmerman, MD, FAAD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Feb 4, 2010
 

Medical Care

Medical care for Peyronie disease is focused on patient education and anecdotally effective medical therapies. See Patient Education.

  • A new possible therapy is an injectable collagenase product, collagenase Clostridium histolyticum (Xiaflex), which was recently approved by the US Food and Drug Administration (FDA) for the treatment of Dupuytren contracture.[10]
  • Pentoxifylline, a nonselective phosphodiesterase inhibitor, has been found to reduce Peyronie disease plaque size and penile curvature in one double-blind, placebo-controlled trial.[11]
  • Other medical therapies are mostly of marginal and anecdotal benefit. Their effects are hard to evaluate because of the variable natural history of Peyronie disease. Although many remedies exist, no one medical therapy is clearly superior to any other. Treatments range from oral vitamin E administration to low-dose radiation to intralesional injections of calcium channel blockers. Acetyl-L-carnitine,[12] propionyl-L-carnitine, verapamil,[13, 14, 15] and interferon alfa-2b[16, 17, 18] have limited but reasonable data sets supporting their use.
  • If erectile dysfunction is present, the condition is unlikely to improve with treatment of the Peyronie plaque alone. The use of sildenafil with an intracavernous injection treatment or a vacuum device is indicated. Intracavernous injections may worsen penile scarring, and the treatments must be monitored carefully. Intralesional injections of interferon alfa-2a may be effective. Also see the clinical guideline summary from the American Urological Association, (1) The management of erectile dysfunction: an update. (2) 2006 addendum.[19]
  • Iontophoresis is the use of an electric current to pull medications through the skin to specific sites. This electromotive drug administration has been used to treat Peyronie disease with various combinations of orgotein, dexamethasone, lidocaine, and verapamil. The technique is experimental. Since 2003, several studies have reported some success with a combination of verapamil, lidocaine, and iontophoresis.[20]
  • Therapies to avoid in Peyronie disease include intralesional steroid injections, which may induce more inflammation, and oral procarbazine administration, which is not effective and may cause blood dyscrasias.[21, 22] Steroid injections (eg, triamcinolone injections) may be contraindicated in the treatment of Peyronie disease. Conflicting reports demonstrating some efficacy to intralesional steroid injections may, in fact, represent the mechanical destruction of the plaques with the volume of fluid injected and not the actual compound itself.
  • Another technique called extracorporeal shockwave therapy, similar to that which is commonly used to destroy kidney and salivary gland stones, has been reported as another treatment modality for Peyronie disease. Conflicting reports and concerns over causing increased inflammation and damage limit the usefulness of this therapy.[23, 24]
  • Radiation therapy has also been used successfully in Peyronie disease, although standardization of treatment and a determination of the optimal regimen is needed.[25, 26]
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Surgical Care

Surgical care for Peyronie disease is focused only on those with significant morbidity and Peyronie disease that is resistant to medical treatment. Surgery may be indicated after a 12- to 18-month observational period during which the Peyronie disease is shown to be stable.

  • For the best results, the Peyronie disease plaques and the angulation of the penis should be stable for several months prior to surgery. Unless the initial inflammatory phase of Peyronie disease resolves, it continues after surgery and increases the likelihood of recurrence.[27]
  • Common surgical correction methods include the following:
    • The Nesbit tuck procedure: Unaffected tunica albuginea is removed from the side of the penile shaft immediately opposite the Peyronie disease plaque to straighten and shorten the penis. For this procedure to work, potency should be normal, and the penile curvature should be less than 60°.
    • Tunica plication procedure: The tunica albuginea is plicated (not excised) to straighten the penis. This technique also causes penile shortening. See the intraoperative and postoperative images below. Intraoperative picture of an artificial erection dIntraoperative picture of an artificial erection demonstrating lateral curvature. Intraoperative picture after penile plication demoIntraoperative picture after penile plication demonstrating a straight erection. Postoperative picture after surgical repair demonsPostoperative picture after surgical repair demonstrates a straight erection.
    • Plaque excision and grafting: This procedure may be performed to preserve penile length when the curvature is greater than 60°.[28, 29, 30]
    • Plaque excision and penile prosthesis insertion: This method is useful when comorbid severe erectile dysfunction is present.[31]
  • Newer surgical techniques for Peyronie disease include the thinning of the plaque with carbon dioxide lasers.[32]
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Consultations

  • Consultation with a urologist is mandatory for surgical management. Surgical management is indicated when medical management fails or when significant pain and/or a complete inability to have intercourse is present.
  • A sex therapist may provide useful adjunct care, both to underscore the realistic expectations and to evaluate comorbid sexual dysfunction.
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Contributor Information and Disclosures
Author

Jay W Zimmerman, MD, FAAD  Consulting Physician, Berman Skin Institute, Palo Alto

Jay W Zimmerman, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, and California Medical Association

Disclosure: Allergan Consulting fee Consulting; Centocor Consulting fee Consulting; Galderma Consulting fee Consulting; Coria Labs Consulting fee Consulting

Coauthor(s)

Anne Laumann, MB, ChB, MRCP(UK), FAAD  Associate Professor, Department of Dermatology, Feinberg School of Medicine, Northwestern University

Anne Laumann, MB, ChB, MRCP(UK), FAAD is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Illinois State Medical Society, Illinois State Medical Society, Medical Dermatology Society, and Society for Investigative Dermatology

Disclosure: Boerhinger-Ingelheim Consulting fee Consulting; Pfizer Consulting fee Consulting; Astellas Consulting fee Consulting; Alza J and J Grant/research funds Other; Amgen Grant/research funds Other; Basilea Grant/research funds Other; OSI Pharmaceuticals Other; Centocor Grant/research funds Other; Lilly-ICOS Grant/research funds Other; Bavarian Nordic Grant/research funds Other

Gregory Bales, MD  Associate Professor, Department of Surgery, Section of Urology, University of Chicago

Gregory Bales, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Terry L Barrett, MD  Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas

Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD  Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology

Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Consulting fee Consulting; Celgene Honoraria Safety Monitoring Committee; GSK - Glaxo Smith Kline Consulting fee Consulting; TenXBioPharma Consulting fee Safety Monitoring Committee

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Lateral view demonstrates vertical curvature.
Superior view shows a full erection.
Postoperative picture after surgical repair demonstrates a straight erection.
Intraoperative picture of an artificial erection demonstrating lateral curvature.
Intraoperative picture after penile plication demonstrating a straight erection.
 
 
 
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