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Dupuytren contracture - Skin
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Dupuytren contracture - Skin

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Contributors: Laurie Good MD, Jeffrey D. Bernhard MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Dupuytren's contracture is a fibroproliferative condition involving the palmar aponeurosis. At present, the pathophysiology of the disorder is not entirely understood, although several factors are believed to contribute to fibroblastic proliferation and altered collagen profiles, including specific platelet-derived fibroblast growth and transforming growth factors. White men of Northern or Eastern European descent aged 60 years or older are most commonly affected.

Initial symptoms include thickened nodules or plaques (Grade 1), which are followed by fibrous band development (Grade 2). With progression and increased fibrosis, flexion contractures develop (Grade 3). Patients may also present with similar findings in the plantar fascia. Presentation can be unilateral or bilateral, with one hand typically being more severe than the other.

Risk factors include alcohol abuse, tobacco use, and certain family history; evidence supports an autosomal dominant pattern of inheritance. A 2011 study identified nine loci associated with genetic susceptibility to Dupuytren's contracture; six of the loci contain genes that encode proteins in the Wnt-signaling pathway, and the authors postulate that aberrations in this signaling pathway are related to the process of fibromatosis in the disease.

A small portion of patients with Dupuytren's contracture also develop Peyronie's disease.

Pediatric Patient Considerations:
Rarely the condition can present in pediatric patients, though the clinician should be mindful of epithelioid sarcoma.

For more information, see OMIM.

Codes

ICD10CM:
M72.0 – Palmar fascial fibromatosis [Dupuytren]

SNOMEDCT:
274142002 – Dupuytren's contracture

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

The differential diagnosis includes: Pediatric Patient Considerations:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 03/29/2017
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Dupuytren contracture : Hand pain, Smooth nodule
Clinical image of Dupuytren contracture
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