April 24, 2025 Author : João Borges (Plastic Surgery) Dupuyten's disease, also known as palmar fibromatosis or Dupuyten's contracture, is characterized by increased thickness, proliferation and retraction of the palmar aponeurosis or fascia. This structure is located between the skin and the muscles, tendons, vessels and nerves of the palm of the hand. It is a chronic disease with a progressive evolution , generally slowly, over several years. Initially, thickening of the palmar fascia manifests itself with the appearance of hard nodules on the palm of the hand, which may or may not be painful; The nodules gradually evolve, forming fibrous cords or bands that extend from the palms of the hands to the fingers; The retraction of these bands causes progressive flexion of the fingers, which can reach the position they have with a closed hand (90 degree angle at the metacarpophalangeal and interphalangeal joints). Palmar fibromatosis usually affects both hands, but it can also affect just one. It most frequently affects the ring finger, followed in order of frequency by the little finger, thumb, middle finger and index finger. In more advanced stages of the disease, it is no longer possible to extend the fingers . The ability to grasp objects can be seriously affected with consequent functional disability. Causes of palmar fibromatosis The exact cause of this disease is unknown, but it is known that there are factors that predispose to its development : Sex , being more common in men, who also tend to have a more severe and faster-progressing disease; Age , with the development of Dupuyten's disease being more common after the age of 50 and the prevalence increasing with age. When it occurs in youth, the progression is faster and the symptoms are more severe; Race/ethnicity , knowing that it affects more people with Northern European ancestry and less those with African or Asian ancestry; Personal history of other localized fibroses , such as plantar fibromatosis or Peyronie's disease; Personal history of some chronic diseases , including diabetes, epilepsy and chronic liver disease (often associated with alcoholism), occurring in: 16%-42% of people with diabetes; 25% in people with alcoholism. Family history of Dupuyten's disease, with almost 70% of men with a family history being affected; Environmental factors, such as alcoholism, smoking; Occupational factors, being twice as common in professions where there are manual tasks or repetitive vibration of the hands. Furthermore, when there is a genetic predisposition to Dupuyten's disease simultaneously with diabetes, epilepsy or alcoholism, the symptoms generally appear earlier. Treatment of Dupuyten's disease There is no definitive curative treatment for this disease, but there are treatments that help alleviate symptoms , to compromise functionality as little as possible. In less severe presentations of the disease, a rupture/section of the fibrous bands is performed percutaneously , using specific needles and injection of enzymes and corticosteroids. This approach allows temporary relief, but recurrence is the rule. Open surgery is reserved for the most serious cases, when functional incapacity already exists or is anticipated. The surgery is performed in a operating room under anesthesia of the affected limb (brachial plexus anesthesia) or general anesthesia; It consists of incising the skin and excising the fibrous bands that cause retraction of the palm of the hands and flexion of the fingers; Skin sutures are removed between days 10-15; A physiotherapy program is then started to rehabilitate the affected hand. The experience of the surgical team is a very important factor to take into consideration, since the fibrous tissue to be excised has a very close relation with the vessels and nerves of the hand. After surgery for Dupuyten's disease, recurrence requiring re-intervention is more common in earlier presentations of the disease. Reference Aggarwal R, Blazar PE. Dupuytren’s contracture. www.uptodate.com Meet the reconstructive and aesthetic plastic surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
