Xiaflex is an injectable medication FDA-approved to treat two conditions caused by excess collagen buildup: Dupuytren’s contracture in the hand and Peyronie’s disease in the penis. It works by breaking down the tough collagen structures that cause fingers to curl inward or the penis to curve abnormally, offering a nonsurgical alternative for both conditions.
How Xiaflex Works
Xiaflex contains enzymes derived from bacteria that specifically target and dissolve collagen, the structural protein that forms the problematic cords and plaques in both conditions it treats. The medication contains two types of these enzymes. One attacks the outer portions of collagen fibers, while the other breaks apart internal segments. Together, they weaken and dissolve the abnormal collagen tissue from multiple angles, allowing the affected area to be physically straightened or remodeled after injection.
The injection is placed directly into the collagen structure causing the problem, whether that’s a cord in the palm or a plaque in the penis. This targeted delivery means the enzymes work locally rather than throughout the body.
Dupuytren’s Contracture
Dupuytren’s contracture occurs when thick cords of collagen develop in the palm, gradually pulling one or more fingers into a bent position. Over time, affected fingers can curl so far inward that you can’t lay your hand flat, making it difficult to grip objects, shake hands, or put on gloves. Xiaflex is approved for adults who have a cord you can feel under the skin (a “palpable cord”) that’s causing a contracture in a finger joint.
During treatment, a trained provider injects Xiaflex directly into the cord. About 24 hours later, the provider performs a finger extension procedure, essentially manipulating the finger to snap the weakened cord and straighten it. This injection-and-extension cycle can be repeated up to three times per cord, with roughly four weeks between sessions. Up to two injections can be given in the same hand during a single visit if two cords or joints are involved.
In clinical practice, results are strong. One study found that 77% of treated joints reached near-full extension (5 degrees or less of remaining contracture) after just a single injection. Joints with milder starting contractures responded better: those that succeeded had an average pre-treatment bend of about 42 degrees, while joints that didn’t fully respond started at an average of 64 degrees. Both the large knuckle joints and the middle finger joints responded well, though knuckle joints had a slightly higher success rate (80% vs. 57%).
Peyronie’s Disease
Peyronie’s disease develops when a hard plaque of collagen forms inside the penis, causing it to curve during erection. The curve can cause pain, make intercourse difficult or impossible, and create significant psychological distress. Xiaflex is approved for men with a plaque they can feel and a curvature between 30 and 90 degrees. Both the American Urological Association and the European Association of Urology recommend it for dorsal (upward) or lateral (sideways) curvature in this range.
Treatment follows a specific cycle. Each cycle involves two injections given one to three days apart, followed by a penile modeling procedure where the provider manually stretches and reshapes the tissue. Up to four treatment cycles can be administered per plaque, with about six weeks between cycles. That means the full course of treatment can take roughly six months.
What Recovery Looks Like
For Dupuytren’s contracture, the work doesn’t stop after the injection and extension procedure. You’ll typically need to perform stretching exercises for about one minute every waking hour until your follow-up appointment, usually two weeks later. These exercises focus on three things: massaging the palm and fingers to reduce swelling, making a tight full fist to squeeze out fluid and restore flexion, and fully straightening each finger using specific techniques to relax the forearm muscles. Many patients are also fitted with a rigid extension splint to wear every night for the first two weeks.
Swelling, bruising, and soreness in the hand are expected. Skin tears at the injection site can occur during the finger extension procedure but don’t appear to affect outcomes. In the study mentioned above, joints with skin tears had a success rate of 72%, nearly identical to the 79% rate in joints without tears.
For Peyronie’s disease, patients perform penile modeling exercises at home between treatment cycles. The goal is to gently stretch the plaque while it’s weakened by the injections, gradually reducing curvature over the course of treatment.
Who Can Administer Xiaflex
Xiaflex is only available through a restricted distribution program. Providers must complete a training program that includes reviewing procedural videos and guides, then formally enroll themselves and their practice site before they can order or administer the medication. For Dupuytren’s contracture, the provider needs to be experienced in hand injection procedures. For Peyronie’s disease, the provider is typically a urologist with specific training in the injection technique.
Before each injection, your provider is required to give you a medication guide outlining the risks and to discuss potential complications. Severe allergic reactions, though rare, are possible, and treatment facilities need to be prepared to manage them. The restricted access program exists because improper injection technique carries real risks: injecting into the wrong structure in the hand could damage a tendon, and misplaced injections in the penis could cause serious injury.
Xiaflex vs. Surgery
For both conditions, Xiaflex provides a nonsurgical option that avoids general anesthesia, large incisions, and the longer recovery times associated with open surgery. Dupuytren’s surgery (fasciectomy) typically involves removing the diseased tissue and can require weeks of hand therapy afterward. Xiaflex treatment is done in an office setting, with most patients returning to light hand use much sooner.
That said, Xiaflex isn’t appropriate for every case. Patients who’ve had surgery on the same joint within the previous 90 days aren’t eligible for injection. Joints with more severe contractures (above 60 to 65 degrees) have lower single-injection success rates and may ultimately need surgical intervention. Recurrence is also possible with any treatment approach, including Xiaflex, though early data shows low recurrence rates in the months following successful injection.