Dr. Andrew Foret, Hand and Wrist Specialist
Our hands are such an integral part of everyday life that it's hard to imagine a passing hour without having full use of them, whether it's shaking someone's hand or picking up a pencil to write a note. There are numerous health conditions that threaten the mobility of our hands and fingers; among them is a lesser known condition known as Dupuytren's disease. Dupuytren's disease is characterized by abnormal thickening of the tissue just below the skin. This thickening, which appears as pits and nodules, occurs in the palm and can extend through the fingers. The condition can also affect the knuckles. Although typically painless, Dupuytren's disease can cause fingers to turn inward to the palm.
There can be some initial discomfort as the disease develops, but it often fades. The biggest issue with hand diseases such as Dupuytren's is the limited mobility it creates in the hands and fingers. Some patients will only experience minor disruption and won't require medical intervention, but others will develop severely contracted fingers, which creates increased difficulty when performing everyday living tasks, such as washing, shaking hands, even buttoning shirts.
According to the American Society for Surgery of the Hand, there is no known connection between Dupuytren's disease and a specific occupation. Causes of the condition are also unknown, although it appears to be more prevalent in men over age 40 of northern European descent. Progression of the disease is individual-specific and difficult to predict, although those who develop more severe cases typically experience earlier onset.
Open surgery is a treatment option for Dupuytren's disease, but there are several less invasive options available. As with any adverse health condition, treatment options depend on the severity of the disease, the age of the patient, lifestyle, skin condition, medical history and general health. When the fingers curl into the palm, the disease is known as Dupuytren's contracture. Surgery is usually considered in those with a contracture of at least thirty degrees, but there are certainly other options.
Among the newest treatment options is Xiaflex, a collagenase injection treatment. The Xiaflex injection was approved by the FDA as the first nonsurgical options for the treatment of adult patients with Dupuytren's contracture. Treatment is considered for patients with contracture at certain joints of at least 20 degrees. Xiaflex is injected into the affected area in an in-office procedure. The enzymes break down the collagen which creates Dupuytren's contracture. Treatment can be administered once every four weeks for up to 3 doses or until the contracture is released. Common mild side effects include mild pain or tenderness, cracked skin or underarm discomfort.