A common disease that affects the hand is Dupuytren’s contracture: the tissue under the skin of the palm thickens, causing, in some cases, the bending of one or more fingers over time. This is precisely the element that makes intervention necessary, an intervention that can be solved using a drug, without resorting to surgery, as explained by Dr. Alberto Lazzerini, Head of the Humanitas Hand Surgery Unit.
For reasons which are still unknown today, the connective tissue of the palmar fascia gets fibrous. Nodules form, and they can evolve and take on an elongated shape, like strings. In the more severe cases of Dupuytren’s contracture, the patient can’t stretch the finger or fingers affected, which very often involves the ring finger and the little finger. The functionality of the hand is thus impaired: ‘In the presence of flexion retraction of the finger or fingers affected by the contracture, surgery is needed. Therefore, its goal is not to cure nodules but finger retraction’, emphasizes Dr. Lazzerini.
In 30% of cases the contracture comes back
‘Until recently – continued the expert – the first choice for Dupuytren’s contracture was surgery. Nowadays we resort to a collagenase-based drug that is injected to dissolve the nodules. After that, by performing an extension movement, the contraction is completely resolved within 24 hours. The drug is very powerful and therefore only in some authorized centers, where hand surgeons operate, it is possible to perform this type of intervention’.
The operation can also be repeated if the contracture reoccurs: ‘The recurrence of Dupuytren’s disease is very high, appearing in one in three patients and regardless of treatment. This is one more reason to prefer conservative intervention to surgery’.
If, on the other hand, the contracture is mild, the patient does not feel pain and still manages to use the hand without significant functional limitations, the treatment simply involves the monitoring of the evolution of the disease.
An illness that affects the male gender more frequently
Dupuytren’s disease more often affects men than women and in males, its onset is anticipated after the age of 40, while in women it occurs more often after age of 60. The pathology has a progressive evolution and if the onset is early, it can more easily worsen. Family history is one of the non-modifiable risk factors associated with the disease; with regard to the lifestyle, cigarette smoking could increase the likelihood of contracture onset.