Treating Dupuytren's Contracture - Medication and Nonsurgical Options

Treating Dupuytren's Contracture: Medication Options

Dupuytren's contracture is a progressive hand condition where thickening of the palm's fascia tissue causes bending of one or more fingers. While surgery is often necessary, medication can help manage symptoms and slow progression in some cases. Understanding current drug therapies for Dupuytren's contracture is key to finding the right treatment plan.

Overview of Dupuytren's Contracture

Dupuytren's contracture develops when fibrous tissue in the palm thickens and tightens over time. This causes contractures—a pulled-down bending of the fingers that worsens gradually. The ring and pinky fingers are most often affected. In advanced cases, the fingers may become permanently fixed in the bent position.

While not life-threatening, Dupuytren's contracture can cause disabling hand stiffness and reduced dexterity. Activities like shaking hands or putting gloves on become difficult. Specific causes are unknown, but risk factors include:

• Older age
• Male gender
• Northern European ancestry
• Family history
• Smoking
• Diabetes
• Liver disease
• HIV
• Anti-seizure medications

Goals of Medical Treatment

There is no cure for Dupuytren's contracture. However, prescription medications may help:

• Slow down disease progression
• Reduce contractures
• Relieve symptoms like pain and swelling
• Delay or avoid surgery

Medications are often used in early-stage or mild Dupuytren's, while severe finger contractures usually require surgery. Injectable drugs may also be used alongside surgical procedures to improve outcomes.

Corticosteroid Injections

Corticosteroid injections are the most common non-surgical treatment for Dupuytren's contracture. Steroids help decrease inflammation and collagen deposition in the fascia tissue of the palm. This may temporarily improve finger contractures.

Potential benefits of corticosteroid injections:

• Improve finger extension
• Reduce nodules and cords
• Relieve pain
• Delay disease progression and need for surgery

However, effects are temporary, lasting 3-12 months. Repeat injections carry risks like skin atrophy, depigmentation, and nerve injury. Not all patients respond to steroids.

Collagenase Injections

Collagenase injections like Xiaflex contain purified enzymes that break down collagen buildup. This helps weaken contracted cords and straighten bent fingers. It is the only FDA-approved drug treatment for Dupuytren's contracture.

Benefits of collagenase injections:

• Improve contractures better than placebo
• Effective for mild-moderate contractures
• Minimally invasive
• Can delay or avoid surgery

On average, treated fingers regain 35-40 degrees of extension. Multiple injections are required, with some risk of tendon rupture or allergic reaction. Long-term durability is still being researched.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs like ibuprofen help relieve inflammation and pain associated with Dupuytren's contracture. They do not alter disease progression. NSAIDs may be used after collagenase injections to manage post-procedure discomfort. They help some patients better stretch and extend the affected hand.

Vitamin E and Other Antioxidants

Some early research suggested vitamin E supplements might help stabilize Dupuytren's contracture. Vitamin E has antioxidant properties and may counter collagen production. However, later studies found no clear benefit for halting progression or preventing recurrence after surgery.

Other antioxidants like selenium, turmeric, and lutein have also been proposed as potential Dupuytren's therapies. But current evidence does not support their use. More research is needed on antioxidants for Dupuytren's treatment.

No Standard Medication Protocol

There are no medications specifically approved to stop or slow the progression of Dupuytren's contracture. Treatment plans are highly individualized based on:

• Stage and severity of contractures
• Impact on daily activities
• Age and health status
• Response to previous therapies

Mild cases may be monitored with no treatment until progression warrants intervention. Talk to your doctor about medication options best suited for your situation.

Nonsurgical Options for Treating Dupuytren's Contracture

In addition to medications, there are other nonsurgical therapies that may be incorporated into a Dupuytren's contracture treatment plan. Options include:

Needle Aponeurotomy

With needle aponeurotomy, a needle is used to puncture and rupture the contracted cords pulling fingers down. Usually done under local anesthesia, it helps straighten the finger but does not remove the diseased tissue. Benefits tend to be temporary but it can delay surgery.

Radiation Therapy

Low doses of radiation aim to soften and shrink Dupuytren's contracture cords. Research shows it may temporarily improve finger contractures, but effects wear off by 5 years. Risks like skin irritation also limit its use.

Physical and Occupational Therapy

Stretching exercises, massage, and splints help preserve finger mobility and hand function for Dupuytren's patients. Therapy may also improve hand strength and reduce pain. It is often used post-surgery but also provides some nonsurgical benefit.

When is Surgery Needed for Dupuytren's Contracture?

For advanced or rapidly progressing Dupuytren's contracture, surgery is generally required to restore finger extension and improve hand function. Common surgical procedures include:

Fasciectomy

This removes the diseased cords and fascia tissue causing contractures. It is the most effective treatment for improving finger straightening but requires prolonged hand therapy after surgery.

Fasciotomy

This cuts the cords without removing tissue. Less invasive than fasciectomy but has a higher recurrence risk. Often used for milder cases.

Dermofasciectomy

Removes fascia and overlays skin graft over the affected tissue. Aggressive surgery but very low recurrence rates. Used for severe contractures.

Surgical outcomes are best when Dupuytren's is detected early and contractures are still mild. Closely monitoring disease progression with your doctor is important to determine optimal treatment timing.

The Role of Medication in Dupuytren's Care

While medication cannot reverse or cure Dupuytren's disease, it can provide symptom relief and delay progression in some patients. Corticosteroid injections and collagenase offer the greatest potential to temporarily improve finger contractures, while NSAIDs mainly offer pain relief.

However, variable patient response and possible medication side effects mean treatments must be tailored to the individual. Medications are just one part of an overall management plan. Close monitoring of disease progression and discussion of all treatment options with your doctor is essential to minimizing Dupuytren's impact on hand function.