In Reply:

Abstract

Dr Al-Qattan makes an interesting point of performing a study on the injection of triamcinolone and collagenase in combination. I think this might be a worthwhile undertaking. My group at the University of Kansas performed an in vitro study in which collagen was incubated for 48 hours with nothing, triamcinolone alone, hydrocortisone alone, collagenase alone, triamcinolone and collagenase, and collagenase and hydrocortisone. After 48 hours the yield of salt-soluble collagen was measured. With nothing added to the collagen, there was no yield of salt-soluble collagen, as was the case when triamcinolone and hydrocortisone were added alone. But when collagenase was added a definite yield of salt-soluble collagen was obtained; that yield was doubled with the addition of triamcinolone, whereas the addition of hydro-cortisone to collagenase yielded acid-soluble collagen which is not soluble in the body. 1 Ketchum LD Robinson DW Masters FW The degradation of mature collagen: a laboratory study. Plast Reconstr Surg. 1967; 40: 89-91 Crossref PubMed Scopus (36) Google Scholar Therefore, on the basis of that in vitro study, it does theoretically make sense to combine triamcinolone with collagenase in the injection of nodules of Dupuytren's disease.