From the FDA Drug Label
The optimal pH range of collagenase is 6 to 8. Cleansing materials such as Dakin’s solution and normal saline are compatible with Collagenase Santyl◊ Ointment There is no information in the provided drug label about the diagnosis of Dupuytren's contracture. For the treatment of Dupuytren's contracture, the label does mention collagenase but does not provide direct information on its use for this condition. 1
From the Research
Dupuytren's contracture should be treated with surgical fasciectomy for severe contractures, while moderate cases may benefit from collagenase injections or needle aponeurotomy, and mild cases can be managed with observation and stretching exercises. The diagnosis of Dupuytren's contracture is based on the presence of a palpable cord and flexion contracture of the metacarpophalangeal or proximal interphalangeal joints.
Treatment Options
- Mild cases: observation and stretching exercises may be sufficient
- Moderate cases:
- Collagenase injections (Xiaflex) can enzymatically dissolve the contracted tissue, with satisfactory results and moderate long-term efficacy 2
- Needle aponeurotomy (using a needle to break up cords) is also a viable option
- Severe contractures: surgical fasciectomy is the mainstay treatment, providing durable results 2
Post-Treatment Care
Post-treatment hand therapy is essential for optimal outcomes, regardless of the treatment chosen.
Considerations
The condition has a genetic component and is more common in men over 50, people of Northern European descent, and those with certain conditions like diabetes or alcoholism 3. While not painful, Dupuytren's contracture can significantly impact hand function when fingers can't fully extend. Treatment should be considered when the contracture causes a "tabletop test" to be positive (inability to lay the hand flat on a table) or when daily activities become difficult. Recurrence is possible with all treatments, and early intervention generally yields better functional outcomes. A recent study comparing collagenase injection with limited fasciectomy found that collagenase injection was not noninferior to limited fasciectomy with respect to the score on the Patient Evaluation Measure-Hand Health Profile at 1 year after treatment 4.