What is the role of corticosteroid injection in the treatment of Dupuytren contracture?

Updated: Mar 02, 2020
  • Author: Eva Kovacs, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Intralesional triamcinolone acetonide (Kenalog-40) injections of 40 mg/mL have yielded subjective improvement in the size of Dupuytren nodules in some patients. In one study by Ketchum et al, patients received 60-120 mg injections of triamcinolone acetonide directly into the nodule, resulting in nodule regression in 97% of the hands after an average of 3 injections. However, 50% of patients experienced recurrence of nodules 1 to 3 years after their last injection, and those with mild MCP contractures (< 15º) did not have improvement in their contractures. [93]  Ketchum argues that early treatment of a nodule with an intralesional steroid injection, before the development of joint contracture (particularly PIP joint involvement), can interrupt the inflammatory process and thus the progression of disease. [94]

However, corticosteroid injections are associated with a high risk of complications, including fat atrophy and skin discoloration, [64] although in Ketchum et al's study nearly all patients saw resolution of atrophy and depigmentation by 6 months after the last injection.  [93]  In addition, intralesional injection of corticosteroids can result in tendon rupture.


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