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Botox and Dupuytren Disease?

Botox may have a use in the treatment of Dupuytren disease.

Right now, it’s untested, but it has a scientific basis. Botox is not just the botulinium toxin. It’s a biologic extract which contains a number of unique molecules. One of these is C3 transferase, an enzyme which blocks several steps in the pathway of fibrosis. Botox has been reported as a potential treatment for keloid scars and has been shown to reduce contracture, adhesions and fibrosis after experimental surgical wounds:

There is a large clinical experience to support the use of Botox in humans for treatment of benign disease.

C3 transferase based treatment of Dupuytren disease would be directed at prevention rather than correction. Current thought is that nodules, not cords, are the main location of biologic activity which results in contractures, and nodules are a logical starting study focus.

One type of study would be treatment of patients with nodules – and then following outcomes. The problem with this is that many people with only nodules may not develop contractures for decades:

Another option for study would be to add C3 transferase treatment as an adjunct to patients who are undergoing a procedure to correct Dupuytren contracture. The advantage of this would be that patients who are treated for contracture are likely to have recurrent contracture progression in a more predictable and shorter period of time than those who simply have nodules. This would shorten the needed study time and would give more statistical validity. Selection of patients with risk factors for early recurrence (positive family history, both hands involved, onset earlier than 50 years old, knuckle pads, Ledderhose and others) would similarly improve study analysis logistics. This approach has been applied to cortisone injection and perioperative Tamoxifen with encouraging results:

Interest in coordinating a Botox Dupuytren study may be directed to the Dupuytren Foundation:

Charles Eaton MD

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