Bent Fingers or Curved Erections: How Xiaflex ^® Treats Collagen Build-Up Without Surgery

Collagen is an important protein that helps support the body's tissues.¹ However, when too much collagen builds up in certain areas, it can cause problems. In some people, it leads to fingers gradually bending towards the palm (Dupuytren’s contracture), while in others, it can cause the penis to develop a curve during an erection (Peyronie’s disease).^2,3

Understanding why these changes happen and how they can be treated can help patients have more informed discussions with their healthcare provider. This guide explains how Xiaflex^® works and what to expect before, during, and after treatment.

Understanding Dupuytren’s Contracture and Peyronie’s Disease

Dupuytren's contracture is a chronic condition that affects the tissue beneath the skin of the palm, known as the palmar fascia. As excess collagen accumulates, it forms thickened cords that gradually pull one or more fingers, most often the ring and little fingers, towards the palm.⁴

Peyronie's disease (PD) occurs when scar tissue, also called plaque, develops within the penis. This can cause the penis to bend or curve during an erection and, in some cases, may lead to pain, difficulty with sexual intercourse, or emotional distress. The condition has been reported in up to 13% of men. The exact cause is unclear, but it is thought to result from abnormal wound healing after an injury or repeated minor trauma to the penis.⁵

Why Bent Fingers and Curved Erections Need Specialist Evaluation

Bent fingers or a curved erection may seem like minor changes at first, but they can gradually interfere with everyday activities, sexual function, and overall quality of life.^6,7 Consulting a specialist early can help identify the underlying cause, assess the severity of the condition, and determine whether treatments such as Xiaflex^® may be appropriate based on your individual needs.

What is Xiaflex^®?

Xiaflex^® is a prescription medicine that contains collagenase clostridium histolyticum, a combination of bacterial collagenases. It is approved for the treatment of:⁸

• Adults with Dupuytren's contracture who have a palpable cord.
• Adult men with Peyronie's disease who have a palpable plaque and a penile curvature of at least 30 degrees at the start of treatment.

How Xiaflex^® Works on Collagen Build-Up

Xiaflex^® contains collagenases, which are enzymes that break down collagen, the main protein found in the thickened cords of Dupuytren's contracture and the plaques of Peyronie's disease.⁸

When injected into a Dupuytren's cord, Xiaflex^® breaks down the collagen within the cord, which may help disrupt the tightened tissue and improve finger movement.⁸

When injected into a Peyronie's plaque, Xiaflex^® breaks down the collagen within the plaque. As the plaque is disrupted, penile curvature and the symptoms associated with Peyronie's disease may be reduced.⁸

Xiaflex^® for Dupuytren’s Contracture

Xiaflex^® is approved for adults with Dupuytren's contracture who have a palpable cord in their hands.⁸

Treatment involves injecting 0.58 mg of Xiaflex^® directly into the affected cord. If the finger remains bent, a finger extension procedure may be performed approximately 24 to 72 hours later to help straighten the finger. If needed, up to three injections may be given into the same cord at intervals of about 4 weeks. Up to two joints in the same hand may be treated during a single treatment visit.⁸

Xiaflex^® for Peyronie’s Disease

Xiaflex^® is used in adult men with Peyronie's disease who have a palpable plaque and a penile curvature deformity of at least 30 degrees at the start of treatment.⁸

Each treatment cycle includes two Xiaflex^® injections, given 1 to 3 days apart, followed by a penile modeling procedure performed 1 to 3 days after the second injection. If needed, up to four treatment cycles may be given at intervals of approximately 6 weeks. If the penile curvature is reduced to less than 15 degrees, or if further treatment is no longer clinically indicated, additional treatment cycles are not recommended.⁸

Important Safety Risks and Warning Signs Patients Should Know

Before starting treatment, talk to your healthcare provider about the potential benefits and risks and what to expect during and after treatment.⁸

Although most side effects are mild to moderate, serious complications can occur. Seek medical attention immediately if you notice:⁸

• Severe pain or difficulty using the treated finger or hand after treatment for Dupuytren's contracture, as this may indicate a tendon or other serious injury
• Sudden severe pain, swelling, bruising, or a popping sensation in the penis after treatment for Peyronie's disease, as these may be signs of a penile fracture (corporal rupture)
• Signs of a serious allergic reaction, such as hives, swelling of the face, difficulty breathing, chest pain, dizziness, or fainting

If you take blood-thinning medicines (other than low-dose aspirin), tell your healthcare provider before starting Xiaflex^®, as these medicines may increase the risk of bleeding.⁸

Most common side effects after treatment⁸

Recovery, Follow-Up, and What to Discuss with the Doctor

Recovery after Xiaflex^® treatment varies from person to person and depends on the condition being treated. Following your healthcare provider's instructions and attending all scheduled follow-up visits are important to help achieve the best possible results.

After treatment for Dupuytren's contracture, your healthcare provider may perform a finger extension procedure if needed. You may also be asked to wear a splint at bedtime for up to 4 months and perform regular finger stretching and bending exercises to help improve finger movement.⁸

After treatment for Peyronie's disease, you will return for a penile modeling procedure after the second injection of each treatment cycle. Your healthcare provider will also show you how to perform gentle penile modeling exercises at home and advise you when it is safe to resume sexual activity.⁸

How Rx4U May Support Access Through Named Patient Program Guidance

Xiaflex® may not be routinely available in the Indian pharmaceutical market. However, eligible patients may be able to access the medicine through the Named Patient Program (NPP)⁹

Step-by-Step: How to Access Xiaflex® Through the Named Patient Program

 - Consult your healthcare provider

Speak with a healthcare provider experienced in treating Dupuytren's contracture or Peyronie's disease. They will evaluate your condition and determine whether Xiaflex® is an appropriate treatment option.

 - Obtain a prescription and medical documentation

   If Xiaflex® is considered suitable, your healthcare provider will provide a prescription and any supporting medical documents required for the access process.

 - Gather supporting medical records

   Relevant medical records, such as clinical notes, examination findings, or imaging reports, may be needed to support the request and confirm the diagnosis.

 - Complete the regulatory process

   An application is submitted to the appropriate regulatory authority to obtain permission for the import of the prescribed medicine, where required.

 - Access Support Through an Authorized Partner

  Organizations such as Rx4U India can help patients and caregivers understand the Named Patient Program, assist with documentation, coordinate the access process, and provide updates throughout the treatment journey.

Conclusion: Treating Collagen Build-Up Conditions with the Right Guidance

Dupuytren's contracture and Peyronie's disease can affect daily activities, hand function, sexual health, and overall quality of life.^2,3 For eligible patients, Xiaflex^® offers a non-surgical treatment option that targets collagen causing these conditions.⁸ Because treatment requires careful evaluation, specialized injections, and follow-up care, it is important to work closely with an experienced healthcare provider to determine whether Xiaflex^® is the right choice for you.

Medical Disclaimer: 

This information is provided for educational purposes only and is not a substitute for professional medical advice. Medicine should only be taken under the guidance of a qualified healthcare provider. Patients should always consult their doctor for advice on diagnosis, treatment, and medication use, and should not make changes to their prescribed therapy without medical supervision.

References:

 - Cleavland Clinic. Collagen. Last Updated May 23, 2022. Accessed July 27, 2026. https://my.clevelandclinic.org/health/articles/23089-collagen

 - Walthall J, Anand P, Rehman UH. Dupuytren Contracture. In: StatPearls. StatPearls Publishing 2026. https://www.ncbi.nlm.nih.gov/books/NBK526074/

 - Sandean DP, Leslie SW, Lotfollahzadeh S. Peyronie Disease. In: StatPearls Publishing; 2026. https://www.ncbi.nlm.nih.gov/books/NBK560628/

 - Khaliq F, Orji C. Dupuytren's Contracture: A Review of the Literature. Cureus. 2024;16(12):e74945. doi:10.7759/cureus.74945

 - Bilgutay AN, Pastuszak AW. Peyronie's disease: A review of etiology, diagnosis, and management. Curr Sex Health Rep. 2015;7(2):117-131. doi:10.1007/s11930-015-0045-y

 - Wilburn J, McKenna SP, Perry-Hinsley D, Bayat A. The impact of Dupuytren disease on patient activity and quality of life. J Hand Surg Am. 2013;38(6):1209-1214. doi:10.1016/j.jhsa.2013.03.036

 - Low P, Wang L, Li KD, et al. Thematic analysis of the psycho-sexual symptoms in patients with Peyronie's disease present on online forums. Int J Impot Res. 2023;35(6):533-538. doi:10.1038/s41443-022-00589-x

 - Prescribing Information. Endo Pharmaceuticals Inc.

 - Patil S. Early access programs: Benefits, challenges, and key considerations for successful implementation. Perspect Clin Res. 2016;7(1):4-8. doi:10.4103/2229-3485.173779