Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Anton C. de Groot in Monographs in Contact Allergy, 2021
Collagenase clostridium histolyticum is an enzyme produced by the bacterium Clostridium histolyticum and a member of the matrix metalloproteinases that cleaves triple-helical collagen types I, II, and III. It is used as a powder- and-solvent injection kit for the treatment of Dupuytren’s contracture, a condition where the fingers bend towards the palm and cannot be fully straightened, and Peyronie’s disease, a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis. Used in the topical treatment of skin ulcers and severe burns, collagenase is able to digest collagen in necrotic tissue at physiological pH by hydrolysing the peptide bonds of undenatured and denatured collagen. Collagenase thus contributes towards the formation of granulation tissue and subsequent epithelization. The action of collagenase may remove substrates necessary for bacterial proliferation or may permit antibodies, leukocytes, and antibiotics better access to the infected area (1).
Hands
Tor Wo Chiu in Stone’s Plastic Surgery Facts, 2018
Collagenase (clostridium histolyticum) injections are promising. Xiaflex was approved by the FDA in February 2010 for use in DD with a palpable cord (FDA approval for treatment of Peyronie’s disease in 2013). It may be best for MCPJ contractures, but the best indications and longevity remain unclear at this time. An average of 3 injections are needed, with or without ‘finger extension procedures’.
Needle fasciotomy for Dupuytren’s contracture- a prospective cohort study of 58 fingers with a median follow-up of 6.5 years
Published in Journal of Plastic Surgery and Hand Surgery, 2020
A. Zachrisson, A. Ibsen Sörensen, J. Strömberg
Minimally invasive treatment options for Dupuytren’s contracture have become increasingly popular since the introduction of Collagenase Clostridium Histolyticum (CCH), with a renewed interest in NF since the latter method is considerably less expensive [16]. A recent systematic review has concluded that there are no known differences in the outcome between NF and treatment by collagenase [17], but the follow-up time of randomized controlled studies between the two methods have not yet surpassed three years [18]. Our study offer long-term results after NF in a population of mixed contractures, and shows that it is an effective and safe treatment without any serious adverse events. The overall high recurrence rate could be considered acceptable, given that a vast majority of patients with recurrence chose to be treated by NF again.
Pirfenidone as a potential antifibrotic injectable for Dupuytren’s disease
Published in Pharmaceutical Development and Technology, 2022
Suchitra Panigrahi, Amanda Barry, Scott Multner, Gerald B. Kasting, Julio A. Landero Figueroa, Latha Satish, Harshita Kumari
Treatments for DD are only minimally effective. Until now, the treatment mainstay for flexion contractures has been surgical resection (fasciectomy) of the contracted tissue or cords (Davis 2013) with appropriate splinting and hand therapy after surgery. However, this approach has significant risks including damage to digital nerves, blood vessels, and flexor tendons. In addition, it is painful, requires post-operative care, and is associated with high recurrence rates (27–80%) (Rodrigo et al. 1976; Au-Yong et al. 2005). Numerous non-invasive treatment options (Richards 1952; Pittet et al. 1994; Ball et al. 2016) including the administration of intralesional corticosteroids, radiation, and topical creams, yield limited efficacy. More recently, the intranodular injection of collagenase clostridium histolyticum (CCH) and percutaneous needle fasciotomy have been shown to be less invasive techniques (Hurst et al. 2009; van Rijssen et al. 2012; Costas et al. 2017). Approximately 30–50% of patients (Peimer et al. 2015) who received CCH experienced hand swelling, injection site hemorrhage, and pain. Although CCH appears to be a viable non-operative option for DD, contracture recurrence remains an issue (Nayar et al. 2019). Clinically, many of these treatments are still in use with minimal success. Thus, there is an urgent need to develop a local therapy that can mitigate disease progression to contractures and prevent a recurrence.
Phase I and phase II clinical trials for the treatment of male sexual dysfunction—a systematic review of the literature
Published in Expert Opinion on Investigational Drugs, 2018
Paolo Capogrosso, Francesco Montorsi, Andrea Salonia
Randomized trials on the intralesional injection therapy with collagenase clostridium histolyticum (CCH) increased the enthusiasm for a valuable conservative treatment for PD as an alternative to surgery [17]. However, those trials showed an overall mean percentage decrease in the penile curvature of 30–35%, which sometime may not be subjectively relevant for the patient [17]. Likewise, this treatment is currently suggested for a selected group of patients with a stable curvature below 90° and just recently data came out suggesting a potential CCH use over the active phase of the disorder [58]. Therefore, further treatment options are still more than deserved. Among recently published trials, new fibrinolytic and antiinflammatory topical treatments look promising, although the reported effects in terms of curvature and plaque volume reduction are probably too large to be considered realistic and deserve further validation in study with a high number of patients. Once again, SCs therapy would probably gain much consideration in the future, given the strong preclinical evidences reported throughout the last decade [59].
Related Knowledge Centers
- Collagenase
- Enzyme
- Hathewaya Histolytica
- Collagen
- Dupuytren'S Contracture
- Peyronie'S Disease
- Palmar Aponeurosis
- Adhesive Capsulitis of The Shoulder
- Lipoma
- Lymphadenopathy