From the FDA Drug Label
The optimal pH range of collagenase is 6 to 8. The enzymatic activity is also adversely affected by certain detergents, and heavy metal ions such as mercury and silver which are used in some antiseptics Cleansing materials such as Dakin’s solution and normal saline are compatible with Collagenase Santyl◊ Ointment Debilitated patients should be closely monitored for systemic bacterial infections because of the theoretical possibility that debriding enzymes may increase the risk of bacteremia.
The FDA drug label does not answer the question.
From the Research
Percutaneous needle fasciotomy (PNF) is the recommended treatment for Dupuytren's contracture due to its minimally invasive nature, lower complication rates, and comparable outcomes to collagenase Clostridium histolyticum (CCH) injection. This treatment option is supported by a systematic review of comparative studies, which found that PNF had superior clinical outcomes and lower minor complication rates compared to CCH injection 1.
Treatment Options
- PNF: a minimally invasive procedure that can be performed in an outpatient clinic, with limited resources and minimal rehabilitation required 2
- CCH injection: a treatment option that enables rupture of the cord, but is more expensive and has a higher rate of minor complications compared to PNF 2, 1
- Open surgery: may be necessary for more severe cases or as a secondary procedure after recurrence, but is more invasive and has a higher risk of complications 2, 3
Key Considerations
- Early intervention is crucial to manage symptoms and slow progression of the disease
- Patients should seek treatment when finger movement becomes limited or when they cannot place their hand flat on a surface
- Physical therapy is often recommended after treatment to restore hand function
- The condition has genetic factors, with family history being a significant risk factor, and other risk factors include diabetes, smoking, alcohol consumption, and certain medications 4, 5
Recent Evidence
A 2021 systematic review of comparative studies found that PNF had superior clinical outcomes and lower minor complication rates compared to CCH injection 1. Another study published in 2019 found that PNF can be performed in a regular outpatient clinic, with limited resources and minimal rehabilitation required 2. These findings support the use of PNF as a first-line treatment for Dupuytren's contracture.