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[Dupuytren's disease].

Emmanuel Masmejean1, Daniel Tordjman2

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Summary

Dupuytren's disease is a hand condition causing finger contractures due to palmar fascia fibrosis. Current treatments include needle fasciotomy, surgery, or collagenase injections, but recurrence is common.

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Area of Science:

  • Hand surgery
  • Fibrotic disorders
  • Dermatology

Context:

  • Dupuytren's disease involves retractile fibrosis of the palmar fascia, leading to finger contractures.
  • Etiology is unclear, but genetics and diabetes are identified risk factors.
  • Affects middle-aged Caucasian males, with ectopic manifestations like Ledderhose's disease.

Purpose:

  • To review the clinical presentation, risk factors, and treatment strategies for Dupuytren's disease.
  • To discuss the efficacy of various interventions, including needle fasciotomy, surgery, and enzymatic fasciotomy.
  • To highlight the challenge of recurrence and palliative options.

Summary:

  • Characteristic signs include palmar nodules and cords causing contractures; treatment is indicated when hands cannot lie flat.
  • Therapeutic options range from needle fasciotomy for palmar forms to surgical fasciectomy for digitopalmar involvement.
  • Emerging enzymatic fasciotomy with collagenase shows promise, though recurrence remains frequent, necessitating options like dermofasciectomy or arthrodesis.

Impact:

  • Provides a comprehensive overview of Dupuytren's disease management.
  • Informs clinical decision-making regarding the choice of treatment based on disease severity.
  • Highlights the ongoing need for effective treatments to manage recurrence and improve patient outcomes.