Effects of collagen remodulation with Centella asiatica (Centellicum®) in Dupuytren palmar fibromatosis: a pilot supplement study

BACKGROUND: The aim of this pilot, registry study was to evaluate the effects of a specific standardized preparation containing Centella asiatica (Centellicum (R), Horphag Research) used as a supplement for 8 weeks on signs/symptoms and ultrasound imaging (measuring variations in tissue density due to collagen remodulation) in subjects with palmar fibromatosis (PFM). METHODS: All registry subjects - 14 controls receiving standard management (SM) and 14 receiving SM plus a Centella asiatica-(CA -) -based supplement (Centellicum (R), Horphag Research), two 225-mg capsules a day for 8 weeks) completed the study without side effects or tolerability problems. The two groups were comparable. RESULTS: The improvement of signs and symptoms like pain, mobility, thickness and ultrasound echogenicity was statistically more pronounced (P<0.05) in the supplementation group in comparison with the SM group. Particularly ultrasound echogenicity at elastosonography was significantly improved at both hands with supplementation. The number of subjects with the problem and the variation in hand grip were also recorded. Hand grip improved with SM from 25.2 +/- 2.6 kg to 26.7 +/- 2.5 kg; the improvement was statistically significant with the supplement (from 25.6 +/- 2.3 kg to 29.4 +/- 1.3 kg; P<0.05) in comparison with SM. At 8 weeks, diclofenac had been used as a rescue medication by 7 of 14 controls and only 2 of 14 subjects on supplementation. Supplementation with CA appeared to improve signs and symptoms and hand flexibility, possibly by collagen remodulation. The supplement made the palmar aponeurosis softer, more elastic (less echogenic) and mobile, with a better function in only 8 weeks. All main symptoms and ultrasound parameters were improved better (P<0.05) in the supplement group. Oxidative stress was significantly reduced with the supplement (P<0.05) with non-significant variations in controls. CONCLUSIONS: Possibly, the use of Centellicum (R) in the early phases of PFM may avoid a full scarring/keloidal evolution of palmar fibrosis and palmar retraction.