Corticosteroid Injection in the Management of Dupuytren Nodules: A Review of the Literature

Dear Sir, Dupuytren nodules form early in the course of the disease and usually precede the development of joint contracture. These nodules can present with or without pain and can be multiple in numbers (Fig. 1). Currently, although nodules may be symptomatic with pain, no specific intervention is recommended. Treatment is generally delayed until joint contracture develops. There are numerous histopathological studies on the composition of Dupuytren nodules, mechanisms of disease progression, and potential cellular interaction with steroids, but there is a lack of clinical trials on the effect of steroid injections into Dupuytren nodules. Only one study has been completed to determine whether intralesional steroid injections into Dupuytren nodules soften and flatten nodules as well as hasten disease.1 In the mentioned study, 63 patients with Dupuytren nodules in early stages of disease underwent a series of triamcinolone acetonide injections over a 4-year period. Each injection contained 60 to 120 mg of triamcinolone acetonide and was administered directly into nodules of patients with contracture of less than 15◦. Sixty-two of 63 patients experienced visible regression of disease with softening and flattening of nodules. Overall, the study reported an average of 3.2 injections per nodule and 97% of patients experiencing softening and flattening of nodules. Although immediate regression of nodules was observed in these patients, most of them experienced recurrence of disease. Around half of the patients who received a series of steroid injections had a recurrence of disease within 1 to 3 years of the last injection, which required further injections. Only one patient required surgery due to the development of contracture after 10 injections. Some complications noted in the study include depigmentation and dermal atrophy at the injection site from collagen degradation. These complications, however, resolved completely in the majority of patients within 6