Dupuytren’s Disease
What is Dupuytren’s disease?
Have you noticed that the skin on the palm of your hand has become thickened and that your fingers will not go straight any more? It could be that you are suffering from Dupuytren’s Disease. This was first described in 1831 by Baron Guillaume Dupuytren and has borne his name ever since. In this harmless condition the fascia of the hand (tissue just below the skin, not the tendons) thickens and shortens so tethering the fingers.
Thickened tissue in palm
What causes Dupuytren’s disease?
Despite considerable research the exact cause is still not known. It is commoner in men, in some families and in people with Northern European origins (the Viking’s disease). It has been associated with diabetes, smoking and heavy drinking. There is no firm evidence that hand injuries or specific occupations are linked to the disease although an injury can make pre-existing disease worse.
What are the symptoms of Dupuytren’s disease?
This process usually starts slowly with some thickening of the skin in the palm and ‘pits’ where the skin is tethered down. This stage can be tender. Gradually bands of tissue appear along the fingers and contract over a period of six months to five years or more. All the fingers can be affected but the ring and little fingers are most frequently involved.
What is the treatment of Dupuytren’s disease?
Many people never require surgery for this condition but surgery can be considered when the function of the hand is impaired. As a rule of thumb this occurs when you can no longer place your hand flat on a table top. Many operations have been described for this condition. The main options are simply cutting the band in the palm (fasciotomy), lifting up the skin and removing as much of the abnormal tissue as possible (fasciectomy) and removing the skin and abnormal tissue and ‘resurfacing’ the digit with a skin graft (dermofasciectomy). More complex operations have more risks associated but a lower rate of the disease coming back, which is the main difficulty with treatment. Treatment must be tailored to the individual patient. Usually the surgery can be carried out as a day case with the hand being out of action for about 10 days. A splint is often recommended at night, after the wounds have healed, to keep the scar tissue on a stretch as it matures and try and prevent the disease recurring.