Peyronie's disease causes an uncommon sexual dysfunction that results from a bent penis during erection. The disease is characterized by a hard, fibrous layer of scar tissue (plaque) that usually develops under the skin on the upper or lower side of the penis. When the penis is erect, the scar tissue pulls the affected area off at an angle, causing a curved penis. The plaque, formed by thickened layers of erectile tissue, is noncancerous (benign).

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Treatment of Peyronie's Disease
Medical therapy plays a pivotal role in the management of Peyronie's disease and should be performed prior to any surgery. Intraplaque collagenase, intraplaque verapamil, intraplaque interferon, oral acetyl-L-carnitine, oral propionyl-L-carnitine and oral colchicine have proved effective in Peyronie's disease. With the exception of collagenase, these drugs have displayed a number of activities whose final result is to improve immune response, to inhibit inflammation and to inhibit fibroblast metabolism and replication.

Peyronie's Disease Natural Treatment
Acetylcarnitine is an option, use doses less than 300 mg since higher dosages can cause overstimulation and insomnia. I don't have personal experience using acetylcarnitine for Peyronie's disease, so I don't know whether it works or not. One study shows benefit, another does not.

Acetyl-L-carnitine vs tamoxifen in the oral therapy of Peyronie's disease: a preliminary report.
BJU Int. 2001 Jul;88(1):63-7. Biagiotti G, Cavallini G. Andros-Italia, Perugia, Italy.
To detect whether oral acetyl-L-carnitine might be useful in the acute and early chronic phases of Peyronie's disease, compared with tamoxifen, a drug currently in use. The study included 48 patients with Peyronie's disease (15 acute and 33 initial chronic), randomized equally into two groups. The first group used tamoxifen 20 mg twice daily for 3 months and the second acetyl-L-carnitine 1 g twice daily for 3 months. The disease and stages were diagnosed and identified using a history, objective examination, pharmacologically induced erection, autophotography during erection, and basic and dynamic colour Doppler ultrasonography. Penile curvature, plaque size, pain and disease progression were assessed. The differences between the groups or between the variables before and after therapy were compared using analysis of variance or the chi-squared test. Acetyl-L-carnitine was significantly more effective than tamoxifen in reducing pain and in inhibiting disease progression. Acetyl-L-carnitine reduced penile curvature significantly, while tamoxifen did not; both drugs significantly reduced plaque size. Tamoxifen induced significantly more side-effects than acetyl-L-carnitine. These results suggest that acetyl-L-carnitine is significantly more effective and safe than tamoxifen in the therapy of acute and early chronic Peyronie's disease.

Comparison of vitamin E and propionyl-L-carnitine, separately or in combination, in patients with early chronic Peyronie's disease: a double-blind, placebo controlled, randomized study.
J Urol. 2007 October. Safarinejad MR, Hosseini SY, Kolahi AA. Urology and Nephrology Research Center, Faculty of Medicine, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
We compared the efficacy and safety of oral vitamin E and propionyl-L-carnitine, separately or in combination, for the treatment of Peyronie's disease. A total of 236 men (mean age 43 years) with Peyronie's disease were randomly assigned to 4 groups. Group 1 received 300 mg vitamin E orally twice daily. Group 2 received 1 gm propionyl-L-carnitine orally twice daily, and group 3 received 300 mg vitamin E and 1 gm propionyl-L-carnitine orally twice daily. Group 4 (control group) received a similar regimen of placebo during the 6-month treatment period. This study did not show significant improvement in pain, curvature or plaque size in patients with PD treated with vitamin E, propionyl-L-carnitine, or vitamin E plus propionyl-L-carnitine compared with those treated with placebo.

Peyronie's Disease Research
Potassium paraaminobenzoate (POTABA) in the treatment of Peyronie's disease: a prospective, placebo-controlled, randomized study.
Eur Urol. 2005 Apr;47(4):530-5; 
The aim of this study was to investigate the effect of potassium paraaminobenzoate (Potaba) in Peyronie's disease in a prospective, randomized, double-blind, placebo-controlled, multicentre study during a 12-months period of treatment. 103 patients with Peyronie's disease and a history <12 months, non-calcified plaques and without pre-treatment were included. 51 were randomized to potassium paraaminobenzoate, 52 to placebo receiving 4 x 3g/day for 12 months.  The results of this study indicate a significant plaque-related effect of potassium paraaminobenzoate. There was no relevant difference with regard to improvement of pre-existing penile deviation. However, under potassium paraaminobenzoate a significant protective effect on deterioration of penile curvature could be demonstrated. Potassium paraaminobenzoate appears to be useful to stabilize the disorder and prevent progression of penile curvature.

Peyronie's disease: a silent consequence of diabetes mellitus.
Asian J Androl. 2006 Jan;8(1):75-9.
To investigate the clinical characteristics of patients with Peyronie's disease and diabetes mellitus (DM). Methods: During an 8-year period, a total of 307 men seen at our outpatient clinic were diagnosed with Peyronie's disease. Clinical characteristics, penile deformities and the erectile status of patients with PD and DM together (n=102) were retrospectively analyzed and compared to patients with Peyronie's disease alone with no risk factors for systemic vascular diseases (n=97). Results: The prevalence of Peyronie's disease among men with DM and sexual dysfunction was 10.7%. The mean age of diabetic patients with Peyronie's disease was (55.9+/-8.9) years; in the no risk factor group it was (48.5+/-9.0) years (P < 0.05). The median duration of DM was 5 years. The majority of diabetic patients with Peyronie's disease (56.0%) presented in the chronic phase, and they were more likely to have a severe penile deformity (>60 degree) than the no risk factor group. In the diabetic group, the most common presenting symptom was penile curvature (81.4%), followed by a palpable nodule on the shaft of the penis (22.5%) and penile pain with erection (14.7%). A total of 19.6% of patients were not aware of their penile deformities in the diabetic group. Erectile function, provided by history and in response to intracavernosal injection and a stimulation test, was significantly diminished in patients with Peyronie's disease and DM). Conclusion: DM probably exaggerates the fibrotic process in Peyronie's disease. Diabetic patients with Peyronie's disease have a higher risk of severe deformity and erectile dysfunction (ED). Peyronie's disease seems to be a silent consequence of DM and should be actively sought in diabetic men.

Peyronie's Disease questions
Q. I am a male 71 yrs. old, and have had Peyronies (curviture of the penis when erect) for over 5 yrs. Have used a topical otiment for a year with no help. Wondering if there is a herbal tablet that can soften the plac that is making my penis curve and shorten when erect. I have purchased a trial package (8)of Passion RX, and while it gave me more energy and desire. Maybe there is NO help, but I need to ask!!
   A. Peyronie's disease treatment is difficult and we have no magic pills.

Q. I was reading your site on peyronies treatment and the use of acetylcarnitine and potaba and was wondering how effecive they are in reducing the plaque and straightening the penis? I was also on the site -- http://www.peyroniesmd.com/ site by Dr Theodore R Herazy and his enzymes therapy caplet Neprinol, and wonder if you have any comments on that product. I am trying to get some info about some products so I can discuss they with my urologist.
   A. We are not familiar wit Neprinol.  I have personally not treated patients with Peyronie's disease so I don't have good first hand knowledge about this condition.

Q. Regarding combining nattokinase and serrapeptase. There is a product out called Neprinol that combines them and one of the ailments is Peyronies disease. I injured myself and have a plaque buildup on the penis shaft. Would one of these single enzymes help dissolve the plaque? It is about the size of a quarter now and is causing some discomfort. I caught it in a Harley Davidson wheel.
   A. Few human studies are available with either nattokinase or serrapeptase and hence it is very difficult to know what kind of effect the combination formula would have. To be on the safe side, it is advisable to learn how serrapeptase alone and nattokinase alone work for you before considering the combination. We have not seen any studies regarding the role of either enzyme in the treatment of Peyronie's disease.

Q. Have you ever researched the cure for Peyronie's disease?
   A. We don't know of a Peyronie's cure at this time.

Q. In 2001 I started taking glucosamine and MSM in an attempt to provide for long term joint health and reduce popping of joints. Approximately 4 to 5 months later I suddenly developed severe Peyronies Disease. The urologist suggested that I had jammed and damaged the penis; however there was no notable such occasion. There were no other lifestyle changes in the year prior to onset of Peyronies except that I had started taking the glucosamine and MSM. These were immediately discontinued but the Peyronies did not correct. After over a year of the urologist attempting to relieve the Peyronies, I had corrective surgery.
   A. Thanks for letting us know. It is difficult to say in one case report of the association between glucosamine, MSM, and Peyronies disease, but if we receive other reports this will add more confidence to a possible association.

Q. Is there any research where nattokinase and/or serrapeptase enzymes have any effect on Peyronies Disease?
   A. As of July 2008 I have not seen such research.