Elsevier

The Journal of Hand Surgery

Volume 25, Issue 6, November 2000, Pages 1157-1162
The Journal of Hand Surgery

Original Communications
The injection of nodules of Dupuytren's disease with triamcinolone acetonide*,**

https://doi.org/10.1053/jhsu.2000.18493Get rights and content

Abstract

Over a 4-year period 63 patients (75 hands) with Dupuytren's nodules were treated with a series of injections with the steroid triamcinolone acetonide directly into the area of disease. The purpose of this study was to determine whether intralesional injections of triamcinolone acetonide could produce softening and flattening in nodules of Dupuytren's disease as seen in the intralesional injections of hypertrophic scars and keloids. After an average of 3.2 injections per nodule 97% of the hands showed regression of disease as exhibited by a softening or flattening of the nodule(s). Although some patients had complete resolution of the nodules, most experienced definite but incomplete resolution of the nodules in the range of 60% to 80%. Although a few patients did not experience recurrence or reactivation of the disease in the injected nodules or development of new nodules, 50% of patients did experience reactivation of disease in the nodules 1 to 3 years after the last injection, necessitating 1 or more injections. The findings of this study indicate that the intralesional injection of nodules of Dupuytren's disease with triamcinolone acetonide may modify the progression of the disease. (J Hand Surg 2000;25A:1157-1162. Copyright © 2000 by the American Society for Surgery of the Hand.)

Section snippets

Materials and methods

Between January 1986 and January 1990, 63 patients (75 hands) with a diagnosis of Dupuytren's disease were evaluated and treated because of a mass in the palm. Although the conventional approach to a patient with a nodule of Dupuytren's disease is to wait until a joint contracture develops and then surgically release it, in our office patients were also given the option of intralesional injection of the nodule with triamcinolone acetonide. The nodule could be any size and there could be more

Results

In 75 hands (63 patients) undergoing triamcinolone injections into Dupuytren's nodules, all but 2 hands in 1 patient achieved regression of disease (ie, notable softening and flattening of the focus of disease). Little benefit was generally noticed after the first injection in terms of the height of the nodule; almost without exception, the nodules were found to be hard and difficult to infiltrate at the time of the initial injection. The initial injection was considered to be a priming dose.

Discussion

The concept of injecting keloids and ultimately nodules of Dupuytren's disease began to form in the 1960s. A dermatologist informed the one of us (L.D.K.) that he was using a new form of cortisone, triamcinolone, which was introduced in 1960, to treat lichens planus, a plaque-like thickening of the dermis, by intralesional injection. The author transferred the concept to injection of hypertrophic scars, an analogous thickening of the skin. He had his colleague inject half of a pruritic

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*

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

**

Reprint requests: Lynn D. Ketchum, MD, 5701 W 119th St, Suite 215, Overland Park, KS 66209-3721.

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