Collagenase Treatments in Dupuytren's Disease

Dupuytren’s disease is a progressive fibroproliferative disorder of the palmar fascia that leads to the formation of nodules and fibrous cords, causing fixed flexion deformities of the digits and impaired hand function. Traditional management has relied on surgical fasciectomy or needle fasciotomy, but enzymatic fasciotomy using collagenase Clostridium histolyticum (CCH) has emerged as a minimally invasive alternative. Collagenase injections act by selectively cleaving the interstitial collagen in pathological cords, facilitating manual extension of contracted joints without open surgery. Clinical experience has demonstrated rapid restoration of digital extension, often within 24 to 48 hours, with low rates of serious adverse events. Comparative analyses suggest similar functional outcomes to surgery with shorter recovery times and reduced healthcare utilisation. Ongoing refinements in dosing regimens, injection techniques and patient selection aim to optimise efficacy and minimise recurrence, which remains a challenge across all treatment modalities. The adoption of collagenase therapy has been global, with substantial interest in its cost-effectiveness, patient satisfaction and potential for repeat administration in recurrent disease. As multidisciplinary teams integrate enzymatic fasciotomy into broader care pathways, real-world data continue to inform guidelines on timing, technique and long-term surveillance.

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Collagenase Treatments in Dupuytren's Disease publication trend

The graph below shows the total number of articles in collagenase treatments in dupuytren's disease across all publications each year (not limited to Nature Index journals).

Technical terms

Collagenase Clostridium histolyticum (CCH): A bacterial enzyme preparation that selectively degrades type I and III collagen in fibrous cords.

Enzymatic fasciotomy: A minimally invasive procedure using injected enzyme to dissolve pathological fascial tissue.

Percutaneous needle fasciotomy: A technique employing a fine-gauge needle to mechanically disrupt fibrotic cords under local anaesthesia.

Fibroproliferative: Pertaining to abnormal proliferation of fibroblasts and excess extracellular matrix leading to fibrosis.

Palmar fascia: The dense connective tissue layer in the palm that supports flexor tendons and maintains hand architecture.

References

1. Systematic review of non-surgical treatments for early Dupuytren’s disease. BMC Musculoskeletal Disorders (2016).
2. Collagenase Clostridium histolyticum: emerging practice patterns and treatment advances. Journal of Plastic Surgery and Hand Surgery (2016).