Hi wwills ,
I have asked Lemperle about using Xiaflex in the treatment of Granulomas and thats what he said :-
XiaFlex is used since 10 years and I thought of it for the Dupuytren of my wife. If it would be so effective as mentioned in the literature, it would have wiped away operations. In the 70s, I tested Iruxol in dirty wounds - without a significant effect.
I do not doubt the effect of Xiaflex in Dupuytren and maybe Peyronie\'s . However, Triamcinolone does the same in Dupuytren ! - Now, collagenases work on dead or single strands of collagen, only ! and they breakdown these dead (!!!) collagen fibers, not living granulation tissue, which consist to 90 % of living tissue, e.g. macrophages and giant cells and interstitial polysaccharides, not collagen fibers. So, theoretically I doubt XiaFlex\'s great effect in granulomas... and would never pay $ 3000....I am sure that it has little side effects. And in regard of skin
Atrophy after triamcinolone injections is mostly due to technical insufficiency (or massaging !!) during the injection. If it remains within the lumps, it cannot cause
Atrophy. The
Atrophy can easily be bridged with
Restylane until it recovers after 3-6 months.
In this case in particular the doctors injected 40 mg/ml (!!) of Triam. as a basic treatment. So far, I got all granulomas resolved - sometimes after the fifth injections - with rather increasing doses of Triam. - and not the dilution with 5FU. One patient in China needed 240 mg Triam. in the fifth session - because the injection-intervals were always around 6 months - instead of 4 weeks. As I always preach: the success of granuloma treatment depends solely on th right (high!!) dose injected, which is difficult to find, I know. So, I always double the dose from 20mg/ml to 40 mg/ml in the second time if I see little effect. The treatment has to be repeated up to five times every 4 weeks (!) - otherwise,recurrences have to be expected. I have not heard of granuloma fomations after deep injections, e.g. epiperiosteal or epifascial injections as in a penis. So far. As deeper dermal fillers are injected, as safer they are !
Best,Gottfried - this time from Nanking, a former capital, where Japanese troupes massacred 300,000 Chinese within 6 weeks in 1938 .... how war times can convert \"normal\" soldiers - and fathers of own kids - immediately into monsters. And this conversion happens still every year in another part of this World.... Is something wrong with our upbringing or education ??
