Synonyms
Dupuytren’s contracture; fibromatosis of the palmar fascia, Dupuytren’s ́sche Disease
- Ledderhose disease (plantar fibromatosis) = hardening of the sole of the foot.
- Peyronie’s disease (Induratio penis plastica) = hardening of the penis.
- Fasciitis nodularis = hardening on the abdominal wall
In most cases the disease occurs in middle age in men. Only about 15% of those affected are women, who on average fall ill later than men. Dupuytren’s disease occurs mainly in Central and Northern Europe, as well as in North America.
The disease is associated with alcoholism, tobacco smoking and diabetes mellitus, but the exact cause is unclear. A genetic component is now considered to be certain, as there is a generally strong familial incidence. In addition, every third patient reports another disease in the immediate family.
In most cases, the contracture affects the metacarpophalangeal joints of the little or ring finger. As a rule, the disease occurs on both hands. In the area of the hand, there is a strand-like layer of tissue (palmar aponeurosis) between the skin, flexor tendons and nerves.
This layer of tissue has the task of protecting the tendons and nerves of the hand in extreme situations. However, this is no longer guaranteed in the case of Dupuytren’s disease contracture. The fascial tissue (= connective tissue) begins to grow, harden and shorten. The formation of strands and knots in the palmar aponeurosis ultimately results in a bending contracture, which triggers an inhibition of stretching of the fingers
Frequency and gender distribution
This disease is found more often in the north of Europe. Rather rarely people in the southern part (Mediterranean area) are affected. It is estimated that about 1.6 million people in Germany suffer from this disease.
Here men are beyond the 5th decade of life about 10 times as often as women. Younger Dupuytren’s patients often show a pronounced contracture of several fingers. A familial clustering can also be confirmed.
In about 1⁄4 of all cases other family members are also affected by the disease. In 70 to 80 % of all cases both hands are involved. However, the exact cause is still unclear.
What is certain is that the disease causes the palmar aponeurosis (connective tissue in the palm area) to harden and shrink. It is possible that accidents or occupational stress on the hands could be associated with the occurrence of Dupuytren’s disease. In men, the disease is also frequently associated with liver toxicity, for example through alcohol abuse.
In some cases, an increased incidence of contracture has also been observed with long-term use of finasteride. Although the cause is still unclear, the clinical picture is associated with serious diseases. A combination of hereditary disposition and external factors such as microtraumas (= tiny injuries) or other predispositions is assumed.
Scientific studies have shown that in about 25% of all cases other family members are affected by the disease. As already mentioned above, other factors are also likely to have a reinforcing effect. For example, Dupuytren’s disease is more common in diabetes mellitus.
In addition, Dupuytren’s disease often occurs in combination with other rheumatic, autoimmune and fibroblastic diseases. These diseases include, for example: The clinical picture is therefore not locally limited, although it is named differently in other parts of the body. In genetically predisposed individuals, an open injury to the flexor-sided hand or a fracture of the forearm or hand bone can accelerate the development and formation of Dupuytren’s disease.
The fracture or injury as such is then usually the trigger and not the cause.
- Epilepsy
- Alcohol abuse
- Cirrhosis of the liver
- Induratio penis plastica
- Knuckle Cushion
In order to be able to make a detailed diagnosis, it is important that the patient explains all his or her complaints to the doctor. Questions about accompanying diseases, such as diabetes mellitus (“diabetes”), malfunctions of the thyroid gland or fractures in the area of the wrists are also important.Scientific studies have shown that a daily consumption of two glasses of wine or beer is associated with an increased probability of developing Dupuytren’s disease.
Alcohol abuse is considered a risk factor for the disease. This does not mean that every person affected with Dupuytren’s disease drinks too much alcohol. At the same time, low alcohol consumption can have a positive effect on the course of the disease.
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