I have been using transdermal verapamil 15% by www.pdlabs.net for the last 5 months with no visible results. They told me that the cream would remodel the plaque into healthy tissue and while they couldn’t use the word cure they assured me their patented delivery system resulted in proper absorption of the medicine while other compounds were ineffective. They claimed this was one of the main reasons for so much misinformation about it. What do you make of their claims?

Dr. Mulhall answers: I am not familiar with the specific product you mention, however, here is what we know about transdermal therapy. There is not a single medical paper in the literature on the effectiveness of transdermal verapamil (go to PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) to search for papers on Peyronie’s disease) without the use of iontophoresis. We have demonstrated that applying verapamil gel to the skin fails to penetrate the tunica albuginea (Martin DJ, Badwan K, Parker M, Mulhall JP. Transdermal application of Verapamil gel to the penile shaft fails to infiltrate the tunica albuginea. J Urol. 2002 Dec;168(6):2483-5). The use of iontophoresis (a low-grade electrical current, which drives the medicine across the skin) has been shown to allow penetration of the drug into the tunica (Levine LA, Estrada CR, Shou W, Cole A. Tunica albuginea tissue analysis after electromotive drug administration. J Urol. 2003 May;169(5):1775-8). There are 3 papers in the literature that have assessed iontophoresis with various medications and have demonstrated modest curvature improvement. The bottom line here is that much of the hype appears to be driven by considerations other than effectiveness without any supporting evidence that this treatment really works. I do not use this in my practice and have not seen a single patient who has used it who has experienced any benefit. However, it is possible in the future that Verapamil (or other drugs) may be used with iontophoresis in this condition. Of note, Dr. Larry Levine at Rush-Presbyterian Medical Center in Chicago is currently conducting a study assessing iontophoretic delivery of verapamil.