Peyronie’s disease is a condition characterized by the formation of fibrous plaques, or hard scar tissue, in the soft tissue of the penis. This plaque can lead to a noticeable curvature or indentation in the penis, which may cause pain during an erection. The prospect of surgery or injections leads many to explore less invasive options, such as topical creams that can be applied directly to the affected area.
Common Ingredients in Investigated Topical Creams
Topical formulations studied for Peyronie’s disease most frequently feature verapamil as a primary active ingredient. Verapamil is a calcium channel blocker, a medication used to treat high blood pressure. The theory is that by blocking calcium, it can disrupt the cellular pathway that produces collagen, a component of the fibrous plaque, and may help soften or reduce its size over time.
Another compound incorporated into these creams is trifluoperazine, a calmodulin inhibitor. Calmodulin is a protein that binds with calcium and plays a part in the signaling cascade that results in fibrosis. The proposed mechanism is that by inhibiting calmodulin, trifluoperazine could slow or halt the progression of plaque development.
Some formulations also include Vitamin E, an antioxidant explored for various fibrotic conditions. Its inclusion is based on the idea that oxidative stress contributes to the inflammatory processes that initiate plaque formation. A newer topical gel, H-100, combines nicardipine (another calcium channel blocker), superoxide dismutase (an antioxidant), and emu oil as a carrier to help ingredients penetrate the skin.
Scientific Evidence on Efficacy
The central question is whether these creams are effective, and studies have shown mixed results. To date, no topical cream has received approval from the U.S. Food and Drug Administration (FDA) for treating Peyronie’s disease. This lack of approval is because large-scale clinical trials have not consistently demonstrated a significant benefit over a placebo.
Some small, preliminary studies have suggested potential benefits. For instance, a pilot study of a 15% verapamil gel reported improvements in curvature, plaque size, and pain reduction. Similarly, a small randomized trial of a gel named H-100 showed a reduction in penile curvature and pain compared to a placebo group. These early findings have not been replicated in larger, more rigorous studies needed to establish a treatment’s true effectiveness.
As a result, major medical organizations, such as the American Urological Association (AUA), do not recommend topical therapies as a standard treatment. AUA guidelines state that the existing evidence is insufficient to confirm these creams provide a meaningful improvement in penile curvature or plaque size. The guidelines also point out methodological shortcomings in existing studies and the need for more robust data.
Safety and How to Access Creams
For topical creams investigated for Peyronie’s disease, the side effects are considered mild and localized. The most commonly reported issues include skin irritation, redness, or itching at the site of application. These reactions are not severe and often resolve on their own. Systemic side effects are rare because the amount of medication absorbed through the skin is minimal.
Accessing these creams is not as straightforward as an over-the-counter purchase. Because they are not FDA-approved, they are not commercially manufactured or available at a standard pharmacy. Instead, these creams are prepared by compounding pharmacies. A compounding pharmacy is a specialized facility that creates customized medications for individual patients based on a prescription.
A person interested in trying a topical treatment must first consult with a doctor, such as a urologist. If the doctor agrees that a trial is reasonable, they will write a specific prescription detailing the ingredients and concentrations. The patient then takes this prescription to a compounding pharmacy to mix the formulation, which underscores that this is an off-label treatment approach.
Medically Established Peyronie’s Disease Treatments
While topical creams are investigational, there are established medical treatments for Peyronie’s disease proven effective in clinical trials. One primary non-surgical option is intralesional injections, where medication is injected directly into the plaque. The only FDA-approved medication for this is collagenase clostridium histolyticum (Xiaflex), an enzyme that works by breaking down the collagen that forms the plaque, helping to reduce penile curvature and improve function.
For individuals with more severe curvature or for whom injections are not effective, surgical intervention is an established option. One technique is penile plication, which involves placing sutures on the side of the penis opposite the plaque to straighten the shaft. Another procedure is plaque incision or excision and grafting, where the surgeon cuts the plaque and places a graft to allow the penis to straighten.
Penile traction therapy is another approach sometimes recommended, either alone or in combination with other treatments. This involves using a mechanical device to stretch the penis for a set period each day. The goal is to gradually improve length and reduce curvature. These medically recognized treatments form the standard of care and offer predictable outcomes based on substantial clinical evidence.