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Q
What's Dupuytren's Disease?

What can you tell me about Dupuytren's contracture? 

A
Answer (Published 4/9/2007)

Dupuytren's contracture occurs when the connective tissue (fascia) underneath the skin on the palm of the hand thickens and develops knots and cords that can pull some of the fingers in towards the palm. If this happens, you may not be able to straighten out your fingers or use your hand normally. While men are more likely to develop this condition, and it's more common in people over 50, no one knows the cause. However, there appears to be a genetic basis - as many as 70 percent of patients diagnosed with Dupuytren's contracture report having an affected relative. Other risks include alcoholism, diabetes, and epilepsy (here, anticonvulsant drugs may be to blame).

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The first sign of Dupuytren's contracture is often a small, painless lump or series of lumps on one palm. Over time, a cord may form extending from the palm to the ring finger and little finger. The disease rarely affects the thumb and index finger. The condition typically advances slowly but can stop and start and sometimes progress quickly. Dupuytren's usually isn't painful, but you may notice that you can't place your hand flat on a table or desktop. Patients often can use their hands without difficulty, but as the contracture worsens, they may find it hard to fully open the affected hand. Unfortunately, the changes rarely regress.

For those who do develop pain or disability, the only available treatment to improve hand function is surgery. One procedure uses a scalpel or needle to release the abnormal cords of tissue. With this approach, the problem is likely to recur. Another surgical approach, called partial fasciectomy, involves removing as much of the diseased tissue as possible. Dupuytren's can recur afterward but usually not as severely. A third type of surgery is complete fasciectomy – removal of all the connective tissue beneath the skin of the palm. This is a difficult procedure with the highest rate of complications.

An experimental treatment in which enzymes are injected under the skin to break down the knots and cords of tissue has yielded promising results but is available only at the medical facilities doing the research.

If you have rapidly progressing Dupuytren's, ask your doctor about trying a course (3 to 6 months) of Potaba, a prescription drug that is a member of the b-complex vitamins. It is relatively safe and may slow progression of the contracture. Acupuncture and physical therapy may also help relieve any discomfort and improve flexibility, but at present, there are no other alternative therapies I can suggest.

Andrew Weil, M.D.

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