Derm Dx: A growing knot in the palm - Clinical Advisor

Derm Dx: A growing knot in the palm

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A 52-year-old woman complains of a “knot” in her palm that has been increasing in size over the past several months. She has also noted progressive tightness of her fourth and fifth fingers. She denies antecedent injury or repetitive trauma to the hand. Personal history is negative for diabetes and arthritis. She does not smoke but admits to binge drinking. Examination of the affected palm reveals a firm, fixed, readily palpable cord as well as loss of mobility and contracture of the ring finger. No additional joint or skin abnormalities are noted on physical examination. 

In 1831, Guillaume Dupuytren described a deforming, fibrotic condition of the palmar fascia in the hand. The condition is called Dupuytren contraction, and it primarily affects men aged more than 50 years.1The disease is associated with diabetes, alcohol consumption, cigarette...

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In 1831, Guillaume Dupuytren described a deforming, fibrotic condition of the palmar fascia in the hand. The condition is called Dupuytren contraction, and it primarily affects men aged more than 50 years.1

The disease is associated with diabetes, alcohol consumption, cigarette smoking, and HIV infection.2 In addition, Dupuytren contracture has a high genetic predisposition.3 The condition is characterized by firm nodules and cords in the palmar aponeurosis that eventually cause flexion contracture of the affected fingers.

Dupuytren contracture can be treated surgically with either open or closed fasciotomy, which will ultimately result in release of contracture on the cords.4 A nonsurgical approach consists of intralesional injections with collagenase Clostridium histolyticum. This recently described treatment reduces contractures and improves range of motion in joints affected by the disease.5

John Pappas, BS, is a medical student at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. Stephen Schleicher, MD, is an associate professor of medicine at the Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania, and an adjunct assistant professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. He practices dermatology in Hazleton, Pennsylvania.

References

  1. Murrell GA. An insight into Dupuytren’s contracture. Ann R Coll Surg Engl. 1992;74:156-160.
  2. Hahn P. Epidemiology of Dupuytren’s disease [in German]. Orthopade. 2017;46:298-302.
  3. Becker K, Tinschert S, Lienert A, et al. The importance of genetic susceptibility in Dupuytren’s disease. Clin Genet. 2015;87: 483-487.
  4. Vesper US, Mehling IM, Arsalan-Werner A, Sauerbier M. Primary intervention in Dupuytren’s disease [in German]. Orthopade. 2017;46:336-341.
  5. Bear BJ, Peimer CA, Kaplan FTD, Kaufman GJ, Tursi JP, Smith T. Treatment of recurrent Dupuytren contracture in joints previously effectively treated with collagenase Clostridium histolyticum. J Hand Surg Am. 2017;42:391.e1-391.e8
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