Treatments tried over the years with varying levels of success
Mechanical treatments
ESWT or shockwave treatment. is a non-invasive, drug free treatment that takes about five minutes. Sudden bursts of sound are directed into the palm and fingers to loosen the tightening cords pulling the fingers. The vital characteristic of a shockwave is that from zero decibels to high must happen in a few nanoseconds.
The fast moving sound wave hits the tightened cord and stretches it. Moreover, it activates stem cells to migrate to the site because through the nerves the brain has detected a problem and is instructing white blood cells to make a repair. The patient will feel the shockwaves and it mayl be uncomfortable, some would even say painful.
Shockwave treatment has Nice guidance for Peyronie’s and for tennis elbow. It is also used outside
the NHS for Ledderhose, Dupuytren’s and sometimes frozen shoulder, with varying results according to some private studies in Germany.
Laser (low lever laser) accelerates ATP production, increases micro circulation, formation of blood vessels, lymph vessels and collagen synthesis enhanced ( not wanted for Dupuytren’s?) It stimulates nerve endings to produce endorphins and thus reduces pain.
Ultrasound – causes heat in the tissues by creating slight vibrations in the cells. This heat increases oxygen and blood flow, and can break the disulfide bonds in the collagen. However some people also suggest it can increase the amount of fibroblasts if used for healing in wound-areas.
Myofascial release: not remocommended for Dupuytren or Ledderhose tissue as it can cause microtrauma, but may be useful for the arm or leg to release tight tissues caused by using the hand or foot differently, and in some cases for frozen shoulders.
Medical treatments
Acetyl L-carnitine (ALCAR) passes blood-brain barrier, anti-oxidant, neuroprotective. More effective for Peyronie’s than Tamoxifen in 1 study. Improves insulin response so may lower tissue glucose levels?
Alteplase injections- a compound that stimulates cells in the nodules and cords to produce their own collagenase. So far it has been tried on a few Dupuytren’s and Lederhose patients who were happy about the results.
It is already in use as ‘clot buster’ for people with blood clots, so safety studies have been done. It is in use by one doctor in Australia who claims good results, but no publications are available yet.
Botox injection : apart from an enzyme to smooth out wrinkles Botox also contains another enzyme, that is capable of reducing contractions, adhesions and fibrosis, after surgery. it is nit effective in the cords, but can reduce muscle spasms.
Co-enzyme Q10 important in the ATP ( cell energy) chain. Synthesis is reduced with beta-blockers and statins. Found in skin fibroblasts. Anti-oxidant. One or two reports of some improvement but not used generally.
Colchicine gave relief to some Peyronie’s patients when taken oral 3-5 months. It can induce collagenase activity and decrease collagen synthesis
Curcumin via TGFß – induced CCN2 expression is inhibited by PPAR-γ curcumin stimulates PPAR-γ expression
Ginseng inhibits TGFß
Hyaluronidase hyaluronan is a GAG found in healing wounds, contains glucosamines. Used as injectionto treat Ledderhose with patients reporting good results
Imiquinol downregulates TGFß and bFGF
Interferon some types, esp IFN- ɤ but also IFN-α2b can suppress fibroblast contraction, down regulating mRNA for Actin and Fibronectin. However some patient’s cells seem more sensitive than others. Some results for Peyronie’s after intralesional injection.
MAGNESIUM is a calcium antagonist in may functions. As calcium is important for the contractility of collagen, magnesium can block the calcium receptors. Oral magnesium should only be taken if a deficiency is proven by bloodtest or on advise of a doctor, especially high doses. Some patients use magnesium oil for their hands and feet, and have reported increased mobility with that.
NAC (N-Acetyl-L-Cystine) abrogates TGFß signaling and fibrogenesis
Nattokinase ‘clot buster’ or ‘blood thinner’ has amyloid degrading effects
Nicotine has been shown to inhibit myofibroblast differentiation in the human gingiva ( mouth), and thus slow healing of wounds.
Para-amino benzoate (PABA) used for Peyronie’s . Absorbs UVB light (n used in sunscreens, stopped due to allergic reactions) . Precursor of folate but humans can’t convert it into folate.
Considered non essential as food ingredient. Potassium salts called ‘Potaba’ thought to increase O2 uptake in tissues thus increasing function of Mono amino oxidase, which breaks down fibrous tissue. May cause drop in blood sugar levels so take with full meal.
Potassium Amino Benzoate It is not fully understood how potassium aminobenzoate helps break down fibrous tissue. It is thought to increase the amount of oxygen taken up into the tissues. Oxygen is required for a chemical in the body called monoamine oxidase (MAO) to function. MAO acts to break down fibrous tissue. By increasing the levels of oxygen, potassium aminobenzoate is thought to increase the activity of MAO on hard and fibrous tissue
Triamcinolone modulates TGFß and reduces inflammation ( steroid injection)
Verapamil (calcium channel blocker), reduces production of extracellular matrix by fibroblasts and fibroblast proliferation, increases collagenase activity and reduces the production of fibrogenic cytokines. In clinical use for Peyronie’s and sometimes tried for Ledderhose or Dupuytren’s, mainly in gel-form ( but the penetration may be a problem then), sometimes as injection (but the trauma caused by repeated injections is a worry in those cases).
