Dupuytren’s contracture is the thickening of the connecting tissue in the palm and fingers. It usually starts with nodules—tiny lumps—which are sometimes mistaken for calluses or blisters and cause the affected fingers to curl down into the palm of the hand. Even though the origin of this condition isn’t known, experts think it may possess an aspect of inheritance: it’s widespread in Scandinavia, and is often referred to as the ‘Viking disease’. It’s also common among people who have done hard manual labour throughout their lives.
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What are the symptoms?
The disease, which is named after the French surgeon—Baron Guillaume Dupuytren—who first researched it in 1834, presents itself with symptoms that are usually mild and painless. Early symptoms include lumps under the skin in your palms: these nodules might be sore at first. According to NHS Choices, other symptoms can include the thickening of the skin on your palms and overall tenderness in the same area. As this is a progressive condition, with time the lumps may grow into a cord that permanently pulls fingers into the palm of the hand, causing discomfort, pain and—sometimes—even embarrassment. The ring finger is most commonly affected, followed by the little finger and the middle finger. In rare cases, the condition can also impact the toes and soles of your feet. Pay your GP a visit if you notice any of these symptoms. But what steps are being taken in tackling Dupuytren’s contracture?
What kind of treatment is available?
According to NHS Choices, treatment is only required if the condition affects the normal function of your hand. Effective treatment for severe Dupuytren’s disease mainly consists of surgery, some are minor procedures done in under a day. A surgeon can cut or remove the cords that cause the uncomfortable—and sometimes painful—contractures. If a non-surgical approach is preferable (and if the condition is milder), tackling Dupuytren’s contracture can also be carried out with injections of collagenase, an enzyme that dissolves the cords themselves. However, this condition can only be treated and cannot be cured completely: it is likely that the cords will grow back and that further therapy might be needed. In any case, presence of the disease would need to be confirmed by a doctor, as there could be multiple reasons for the appearance of its trademark lumps. In 2010, the National Institute for Health and Care Excellence (NICE) issued guidance about the use of radiation therapy as a way of tackling Dupuytren’s contracture. This other form of treatment involves aiming high-energy radiation at the cords to prevent or delay the need for surgery. As with all treatments, it is best to consider all the possible side effects—and consult with your doctor—before making any decision.
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Common Questions
I have just been diagnosed with Dupuytren’s disease, what are the first steps I need to take?
Dupuytren’s disease is not life threatening, but it can be disabling. In the early stages the only thing to do is to keep a close eye on the lump in your palm. It may never get any worse, and if so, will not impact on your life at all. If a contracture starts, your GP will refer you to a specialist hand surgeon who is experienced in tackling Dupuytren’s contracture.
Is Dupuytren’s disease a lifelong condition and what advice can you give for someone living with the disease?
Yes it is a lifelong condition. Once it starts it does not usually disappear on its own. In about one third of cases Dupuytren’s disease will not cause any problems as far as we know. In those patients where the fingers start to contract into the palm, one of the several available treatments from a consultant hand surgeon would normally be offered and will often allow the patient to recover full use of their hand for some years.
How will having Dupuytren’s disease affect me?
This all depends on the degree of disability and which hands are affected. Unfortunately, because Dupuytren’s disease is highly visible, it can also affect your mental state and result in embarrassment or depression. It is important to remain optimistic about this: there are multiple approaches to tackling Dupuytren’s contracture and these will often restore hand function and appearance for several years.
Answers provided by Swedish Orphan Biovitrum, an organisation dedicated to improving the lives of people affected with rare diseases.
For more information, visit the British Dupuytren’s Society website: dupuytrens-society.org.uk/
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