The central issue of Peyronie’s disease is the infamous Peyronie’s plaque, also called a scar. Peyronie’s disease typically occurs in men between 40 and 65 years of age, although a range of 16 to 80 years is documented; some experts say it can occur at any age. From personal communication with a particular man, I was told that his own Peyronie’s disease was started after a dog bite to the groin – at the age of 10. Nonetheless, it is most important to recognize that all clinical signs and symptoms of Peyronie’s disease originate from the effects of the plaque upon the internal tissue layers (tunica albuginea) of the penis.

A developing Peyronie’s plaque appears in response to either micro-trauma to the small blood vessels from a single injury of great force, or multiple injuries of a small force. While there is strong evidence that genetic factors and drug factors also influence the start of PD, it is trauma that is usually considered to be the most likely cause of the Peyronies plaque or scar.

A Peyronie’s plaque on the cellular level initially consists of fibrin threads deposited in a massive network throughout an area of injury within the tunica albuginea of the penis. Peyronie’s plaques, or scars, later combine the dense threads of fibrin connective tissue with reduced and fragmented elastic connective tissue fibers, as well as excessive amounts of type III collagen material, which happens to be specially inclined to excessive scar development. In about one-third of chronic cases of Peyronie’s disease, calcification of the plaque can occur over time. For more technical information about the Peyronies disease plaque.

The curvature of the Peyronies penis is due to the fact that scar tissue does not stretch as easily or as fully as healthy normal tissue. The normal tunica albuginea is composed of elastin fibers and collagen, although the site of scar tissue from Peyronie’s disease is composed mostly of collagen. This difference in composition of these two tissues is what causes a bent penis to develop during erection.

Eventually as one or more Peyronie’s plaques develop into a mass of hardened tissue in the delicate tunica albuginea, it results in variable pain and penile distortion that most often takes the form of a bend or curve; sexual function is often reduced as a result of direct or indirect affects of Peyronie’s disease, also. The penile curvature of Peyronie’s disease is caused by the dense inelastic scar, or plaque, material that shortens the involved side of the tunica albuginea layer that covers the corpora cavernosa of the penis. In approximately one third of patients, the scarring involves either the top or bottom portion of the penis shaft, occasionally both. The lateral sides of the penis can also be affected by Peyronie’s plaque development, if that area experiences injury.

Peyronie’s plaque not easy to find sometimes

In some men the Peyronies plaque is easily found on manual examination, in others it is found with difficulty, and in some men no Peyronies plaque is ever located. It can be frustrating to have a wicked penis distortion, and still not be able to locate the Peyronie’s plaque.

To locate the plaque or scar material a light and inquisitive touch is most effective. Do not be heavy-handed, or press down into the deeper layers to find the Peyronie’s plaque material, because it is found just below the surface of the skin. And, oh yes, you will never directly see the plaque or scar, since it is not on the surface of the skin, but below. Make peace with the Peyronie’s plaque and do not hate it, just determine how to assist your body to remove it.

To learn about using Alternative Medicine to increase your ability to heal and repair the Peyronie’s plaque, a good place to start is the PDI website, Peyronie’s disease treatment introduction.

Peyronie’s disease plaque and fibrin

The tissue changes that occur in Peyronie’s disease are unique in regard to the Peyronie’s plaque that develops.

In a November 2005 abstract account, Kenneth D. Somers and Dawn M. Dawson, of the Department of Microbiology and Immunology, Eastern Virginia Medical School, Norfolk, Virginia, and Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, reported on their findings concerning the tissue changes that occur in Peyronie’s disease.

To begin this explanation, they remind us that Peyronie’s disease is actually a pathological fibrosis, or a situation in which there is excess fibrin tissue located in a small area to the degree that it becomes a problem for the body. In the case of Peyronie’s disease, this fibrosis also is associated with an excessive deposit of collagen in the same area of the fibrin plaque or scar.

Although the cause of Peyronie’s disease remains unknown, they tell us, injury or trauma has long been thought to be the inciting event. To determine if this is true, they looked at the cellular structure of the Peyronie’s plaque or scar to get an insight into the cause of this condition.

Materials and methods they used

Small samples of plaque tissue was taken from 33 patients with Peyronie’s disease, and control tissue and nodular tissue was taken from the penis of eight patients with Dupuytren’s contracture; both groups of tissue were analyzed for collagen staining, as well as fibrin and elastic fiber structure and distribution.

Their results

As a result of this study they found abnormally stained collagen in 97% of the samples, disrupted elastic fibers in 94% and excess fibrin deposition in 95% of the samples. These same findings were not found in the normal scared tunica albuginea of control patients who did not have Peyronie’s disease. The presence of abnormal fibrin accumulation in Peyronies plaque tissue was detected in a special chemical analysis, while this abnormal fibrin was not found in skin tissue samples from the same patients.

Their conclusions

Their conclusions from this study is that the fibrin deposits in Peyronies plaque tissue is consistent with the theory that repeated minor injury or single major injury to the tunica albuginea results in fibrin being deposited in the tissue spaces at the site of trauma to start this condition.

PDI therapy concept

Peyronie’s Disease Institute has taken the position that it is this excess fibrin deposit within the excess collagen formation that can be safely and easily removed by the use of a battery of systemic enzymes that are specific for foreign fibrin protein in the body. By using natural Peyronie’s disease treatment methods to increase the healing response of the immune system against Peyronie’s disease plaque, it is possible to reverse the abnormal tissue found in the tunica albuginea and therefore eliminate the cause of pain and penile curvature associated with Peyronie’s disease.

Peyronie’s disease is an abnormal collection of fibrous pathological tissue in the deep tissue layers within the substance of the tunica albuginea and the Peyronies plaque; it is also characterized by excessive deposition of collagen within that same plaque material. Even thought the cause of Peyronie’s disease remains unknown, direct injury or repeated small trauma is most often thought to be the two most likely inciting events eventually resulting in Peyronie’s disease.

Materials and Methods

To understand the onset and cause of the Peyronie’s disease plaque or scar tissue that is always present in every case of PD, it is necessary to follow a simple approach that examines for the presence of collagen, elastic fiber, and fibrin content within the PD plaque material and evaluate its distribution.

Peyronies plaque or scar tissue specimens were taken from 33 Peyronie’s disease patient volunteers, and control penile tissue samples and nodular tissue samples were taken from eight patients with Dupuytren’s contracture (a related and similar problem of the hand). These samples were analyzed to determine collagen staining characteristics, and patterns of elastic tissue distribution. In addition, plaque tissue from another 19 Peyronie’s disease patients, control tissue and nodular tissue from Dupuytren’s disease were also analyzed for fibrin in these same samples.

Results

Abnormally stained collagen was found in 32 of 33 plaque specimens (97%), disrupted elastic fibers in 31 of 33 plaque specimens (94%), and abnormal fibrin deposits were also found in plaque tissue from 18 of 19 patients (95%). None of these abnormalities were located in normal or scared tunica from control patients.

Conclusions

These findings of fibrin deposits in Peyronie’s plaque tissue is consistent with the concept that repetitive injury and disruption of the small blood vessels and capillaries of the area results in fibrin deposition in the tissue space and has served to provide insights into the pathophysiology of Peyronie’s disease.

Peyronie’s disease is best known for the plaque, scar or hard lump that causes a curved penis to develop.   Peyronies begins as a localized inflammation, usually as a result of injury of some type. It is currently believed that Peyronie’s disease is caused by vascular trauma or injury to the deeper penis anatomy. Peyronie’s disease is most common in men over 50 years, and the incidence increases with age. This inflammation often progresses to a hardened plaque or scar that reduces flexibility of the tissue of the penis, and results in a bend or distortion during erection due to incomplete filling or restriction of the tissue.  Often, this causes constant pain or pain during erection, and for some men these can prevent sexual intercourse due t physical incompatibility or erectile dysfunction.

Aside from the physical changes, depression and reduced self-esteem are commonly experienced by men with Peyronie’s disease.

Peyronie’s disease is most often treated by urologists, even though there are no approved drug therapies for Peyronie’s disease.  Peyronie’s surgery may be an option for some patients although complications such as worsening of the PD distortion can develop, as well as loss of penile length can occur.   Xiaflex, a type of collagen reducing enzyme, or collagenase, has been experimentally injected into the Peyronie’s disease scar or plaque as an in-office procedure. The purpose of injecting Xiaflex into the PD scar is to soften the scar tissue and improve or reduce the curvature of the penis. Further, this is hoped to improve sexual function and eliminate the distressing negative psychosocial aspects of Peyronie’s disease.

Peyronies Xiaflex trial results

Sponsored and monitored by BioSpecifics Technologies Corp., licensor of Xiaflex, the 12 month phase II open-label trials of Xiaflex showed limited but promising results.  These research tests were conducted to evaluate the ability of Xiaflex to successfully treat Peyronie’s disease, as well as its compatibility and side effect potential.  In this process clinical success was defined as a baseline change of penile angulation of at least 25 percent.

Each of the study participants received three injections of Xiaflex, administered on a separate day, and given over seven to ten day period.  Twelve weeks later, each man received a second series of three injections.  Research subjects were evaluated at three, six, and nine months after the Xiaflex injection series.

The average baseline angulation was 52.8 degrees.  In this study clinical success was achieved at three and six months with 58 percent and 53 percent of patients, respectively.  This would suggest that early success might not last very long or that the improvement to the Peyronie’s disease distortion was temporary.

In this study there were adverse reactions with Xiaflex that were not described in the general media.  The most common adverse reaction was only reported as a problem at the local administration site that was mild or moderate in severity, non-serious, and resolved in time without medical attention.  No comment was made about worsening of the Peyronie’s disease after the nine month time frame as a direct result of repeated injury to the delicate tunica albuginea tissue from the multiple needle injections of the needle used to deliver the Xiaflex.

Tissue changes of Peyronie’s disease are unique

In a November 2005 abstract account, Kenneth D. Somers and Dawn M. Dawson, of the Department of Microbiology and Immunology, Eastern Virginia Medical School, Norfolk, Virginia, and Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, reported on their findings concerning the tissue changes that occur in Peyronie’s disease.

To begin this explanation, they remind us Peyronie’s disease is actually a pathological fibrosis, or a situation in which there is excess fibrin tissue located in a small area to the degree that it becomes a problem for the body.  In the case of Peyronie’s disease, this fibrosis also is associated with an excessive deposit of collagen in the same area of the fibrin plaque or scar that results in a curved penis.

Although the cause of Peyronie’s disease remains unknown, they tell us, injury or trauma has long been thought to be the inciting event. To determine if this is true, they looked at the cellular structure of the Peyronie’s disease plaque or scar to get an insight into the cause of this condition.

Materials and methods they used

Small samples of plaque tissue was taken from 33 patients with Peyronie’s disease, and control tissue and nodular tissue was taken from the penis of eight patients with Dupuytren’s contracture; both groups of tissue were analyzed for collagen staining, as well as fibrin and elastic fiber structure and distribution.

Their results

As a result of this study they found abnormally stained collagen in 97% of the samples, disrupted elastic fibers in 94% and excess fibrin deposition in 95% of the samples.  These same findings were not found in the normal scared tunica albuginea of control patients who did not have Peyronie’s disease. The presence of abnormal fibrin accumulation in Peyronies plaque tissue was detected in a special chemical analysis, while this abnormal fibrin was not found in skin tissue samples from the same patients.

Their conclusions

Their conclusions from this study is that the fibrin deposits in Peyronies plaque tissue is consistent with the theory that repeated minor injury or single major injury to the tunica albuginea results in fibrin being deposited in the tissue spaces at the site of trauma to start this condition.

Peyronie’s treatment concept

Peyronie’s Disease Institute has taken the position that it is this excess fibrin deposit within the excess collagen formation that can be safely and easily removed by the use of a battery of systemic enzymes that are specific for foreign fibrin protein in the body.  When combined with other known methods to increase the healing response of the immune system against Peyronie’s disease plaque, it is possible to reverse the abnormal tissue found in the tunica albuginea and therefore eliminate the cause of pain and penile curvature associated with Peyronie’s disease.

Dimethyl sulfoxide (DMSO) was first synthesized in Germany in 1866.  Since then it has been available as a pulp-industry by-product for many years. Its principle use is currently that of an industrial solvent. While it is in use in medical and surgical treatment, it can be used in DMSO Peyronie’s therapy.

In 1964 Dr. Stanley W. Jacob and others at the University of Oregon Medical School were the first to describe the remarkable medicinal properties of DMSO.  In this first work with DMSO they applied it to intact human skin, and discovered it penetrates rapidly and produces a wide range of pharmacologic actions.  Some of these are anti-inflammation properties, local analgesia, stopping bacterial growth in it presence, increased renal function to reduce edema, a carrier action with drugs it is coupled with, softening of collagen (the primary component of the Peyronie’s disease plaque), nonspecific enhancement of immunity, dilatation of blood vessels, and reduction of blood platelet adhesion.  As a result, DMSO has been used widely to treat various conditions (arthritis and bursitis, acute and chronic musculoskeletal trauma, scleroderma, chronic urogenital disorders, and unresponsive postoperative pain syndromes). To date, little to no local or systemic toxicity or tissue destruction has been noted in humans when DMSO is administered.

Of special interest in Peyronie’s disease treatment, when normal tissue is injured or deteriorates for any reason, the damaged tissue naturally produces chemicals called “free radicals.”  It just so happens that DMSO is a potent scavenger of these radicals, maintaining the normal integrity of cells and tissues. These free radicals exert further harm to the damaged or aging cells, and thus prevent or slow the healing process.  Using DMSO in the treatment of Peyronie’s disease seems to make sense because it can be applied locally over the superficial surface of the plaque region.  Not only that, but it can be used to bring in other therapies directly into that same area – a double benefit. DMSO has been called “the most controversial therapeutic advance of modern times.”  However, the 40 year controversy since it first made medical headlines seems to be bureaucratic and economic, rather than scientific. More than 10,000 articles on the biologic actions of DMSO have been reported in the scientific literature, along with 30,000 articles on the chemistry of DMSO. These reports and studies strongly support the contention that DMSO is a truly significant new therapeutic principle.

Currently, DMSO is a respected and approved pharmaceutical agent in more than 125 countries, but not the U.S. In 1970, the FDA approved DMSO for the treatment of musculoskeletal disorders in dogs and horses. Many veterinarians consider DMSO to be the most valuable therapeutic substance in their armamentarium.  Later, in 1978, DMSO was given FDA approval as a therapy for interstitial cystitis, a painful and disabling urinary bladder inflammation.

In many ways, DMSO is the “aspirin” of our time. If aspirin had been introduced in 1963, as was DMSO, with its multiple beneficial therapeutic properties, aspirin surely would have been similarly restricted.

DMSO became prescriptive for humans in the USSR in 1971, in therapy of various musculoskeletal problems. Dr. V. Balabanova of the Moscow Institute of Rheumatology estimates that approximately 50 percent of the Russian population who have arthritis will receive DMSO as part of their therapy. There are more than one hundred articles in the world’s literature relating to DMSO and arthritis. This widespread and common use is based on the well-established pharmacologic actions of DMSO to reduce pain, reduce inflammation, soften scar tissue and contracted fibrous tissue elements, remove free radicals, increase circulation and stimulate healing.  No one with Peyronie’s disease can deny the value of these functions in the repair of the Peyronies plaque.

Based on research from around the world, DMSO has proven to be an effective treatment for many illnesses that otherwise have no known therapy. DMSO is safer, far less expensive, and at least as effective for a variety of problems for which the medical community is presently using other, less effective, and more costly treatments. In 1972 the National Academy of Sciences evaluated the scientific data on DMSO and determined it was a least as effective as other currently approved treatments for three musculoskeletal inflammatory human conditions. Yet, it has not been given FDA approval for these same conditions. Certainly, one of the most important questions about any new medicinal therapy is safety.  The only potentially serious side effect is the occasional patient who is allergic.  In Peyronie’s disease treatment, this is reduced simply by the small area to which DMSO is applied and the administration of topical vitamin E and urea with the PMD-DOMSO formulation created by PDI.

A careful review of the published literature on DMSO shows there is not a single death which can be  definitely attributed to this agent. Since it first appeared in the mid-1960s, hundreds of millions of treatments have been applied worldwide, showing that DMSO is a substance of extraordinary low tissue toxicity. At that time the FDA had received data submitted by approximately 1,500 U.S. physicians concerning over 100,000 DMSO applications, all showing safety and effectiveness. The pharmaceutical companies submitting this positive data were Squibb, Merck, and Syntex, all who would have suffered economic harm if this inexpensive therapy was made more popular and readily available.  With the withdrawal of their support, all further U.S. DMSO research and documentation of effectiveness has stopped.  Thus, the large drug companies blocked further interest or use in a safe, easy, effective and inexpensive substance that could help stop the progression of Peyronie’s disease, so they could develop drugs in which their profit potential was much greater.

Much of the resistance to the use of DMSO in Peyronie’s disease can be thought to be more political and economic, than scientific.  For these reasons, the Peyronie’s Disease Institute has used DMSO in its therapy program from the onset.   TRH