Dupuytren Contracture Medication

Updated: Nov 16, 2021
  • Author: Eva Kovacs, MD; Chief Editor: Herbert S Diamond, MD  more...
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Medication

Medication Summary

Collagenase Clostridium histolyticum (Xiaflex) was approved for the treatment of Dupuytren contracture by the US Food and Drug Administration (FDA) in 2010. Injected collagenase extracted from C histolyticum weakens and dissolves the Dupuytren cords. [5, 65, 66, 67, 68]

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. Tendon rupture has been described in 0.3% of patients. [5]

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. [65] 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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