The natural history of Peyronie's disease was evaluated in 97 men by means of a questionnaire. Disease duration ranged from 3 months to 8 years. Questions addressed pain, bending, ability for intercourse, over-all effect of the disease, psychological effects, treatments received and degree of disease progression. Approximately 40% of the patients found pain, bending, ability for intercourse and over-all effects to be unchanged during the course of the disease. Bending and ability for relations worsened in 40% of the patients during the same interval, while only 6% had worsening of pain. Of the patients 77% reported psychological effects due to Peyronie's disease, which improved in 28%, did not change in 36% and worsened in 36%. Over-all, 13% of the patients believed the disease to be one of gradual resolution, 47% believed there had been little or no change and 40% believed that the disease pattern was one of gradual progression. We found no statistically significant association between disease duration and spontaneous improvement in penile bending. A similar lack of statistical significance was found when improvement in a variety of categories was compared in patients who received no therapy versus those who received a variety of conventional medical therapies.

We investigated 49 men with Peyronie's disease in a prospectively randomized placebo controlled double-blind study, comparing the effects on plaque size and penile deformity of intralesional purified clostridial collagenase and saline placebo. For the group as a whole, treatment out-performed placebo (p < 0.007). When patients were analyzed with respect to disease severity, those with lesser deformity responded more favorably to treatment. The absolute angular change in patients responding to treatment was small. No significant side effects were noted within a 3-month followup.

We report a patient with bilaterally symmetrical perforated corneal ulcers with formation of anterior staphyloma associated with scrofuloderma. A 22-year-old female in her third month postpartum presented with multiple perforated corneal ulcers bilaterally. There was a presence of a skin lesion that was consistent with scrofuloderma. Fine needle aspiration cytology of preauricular lymph nodes showed evidence of granulomatous inflammation consistent with tuberculosis. Corneal scraping revealed the presence of coagulase-negative Staphylococcus. She was treated with topical fortified combination antibiotics (cefazolin and tobramycin). The corneal ulcer resolved with formation of anterior staphyloma in both eyes. The patient underwent anterior staphylectomy and tectonic keratoplasty in both eyes. Eight weeks postoperatively, her visual acuity improved to 20/200 in both eyes with clear grafts. Scrofuloderma may be associated with recurrent phlyctenulosis. Multiple corneal ulcerations coupled with use of topical steroids may result in corneal perforation and formation of anterior staphyloma.