Dupuytren Contracture Medication

Updated: Oct 05, 2016
  • Author: Stephanie Danielle Mathew, DO; Chief Editor: Herbert S Diamond, MD  more...
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Medication

Medication Summary

In February 2010, the US Food and Drug Administration (FDA) approved collagenase Clostridium histolyticum (Xiaflex) for the treatment of Dupuytren contracture. Injected collagenase extracted from C. histolyticum weakens and dissolves the Dupuytren cords. [2, 97, 98, 99]

Complications associated with collagenase C. histolyticum are common; they include injection site reactions, peripheral edema, bruising, bleeding, and pain. More serious reactions include tendon rupture and complex regional pain syndrome. (To date, tendon rupture has been described in 0.3% of 1082 patients.) [2]

Intermittent reports detail a decrease in the size of nodules with the use of corticosteroid injections. However, corticosteroids are associated with a high risk of complications, including fat atrophy and skin discoloration. [57] In addition, intralesional injection of corticosteroids can result in tendon rupture.

Because Dupuytren contracture is generally painless, analgesic medications usually are not required.

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Enzymes

Class Summary

Collagenase Chistolyticum was approved in February 2010 for percutaneous fasciotomy. Collagenase Chistolyticum is a protease that hydrolyzes collagen and breaks down its triple helix conformation, thus disrupting the Dupuytren cord. It is composed of 2 purified microbial collagenases and is indicated only for those patients with a palpable cord.

Collagenase Clostridium histolyticum (Xiaflex)

This is a proteinase that hydrolyzes collagen in its native triple-helical conformation, resulting in lysis of collagen deposits. Injection into a Dupuytren cord (composed mostly of collagen) may result in enzymatic disruption of the cord. Injection is indicated for Dupuytren contracture with a palpable cord.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

Triamcinolone (Kenalog-40, Aristospan)

Triamcinolone is used in the treatment of inflammatory dermatosis responsive to steroids. It decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability.

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