Dupuytren's disease: A reality in Black Africa.

Long regarded as a disease exclusively found amongst Northern Europeans, Dupuytren's disease was seldom studied amongst Black Africans. Thus, we sought to study the impact of Dupuytren's disease, its etiological, clinical and evolutionary peculiarities on a segment of the Senegalese population. This study analyzed data derived from clinical observations carried out between January 2006 and December 2018. It involved Senegalese subjects with Dupuytren's disease, the patients' history, profession, habitus, clinical findings, therapeutic modalities and disease staging. The population included 20 men and 6 women averaging 63.5 years of age (range 45-77). None of the patients reported a family of Dupuytren's disease. Twelve patients had diabetes, 11 were smokers and 22 were engaged exclusively in manual labor. The condition was bilateral in 14 cases. Tubiana stages N, I, II, III and IV were found in 31, 15, 9, 5 and 6 rays, respectively. Conservative treatment was done in 11 patients. Surgical treatment was carried out in the other 15 patients: needle fasciotomy (N=10) including two bilateral involvement and open fasciectomy (N=7). Functional outcomes were satisfactory. Lesions were all stable in the short and medium term. Two patients had progressive lesions on a longer-term basis. Dupuytren's disease is real among Afro-descendants from Senegal even though it is seldom studied. Based on the patients' recollection of Dupuytren's disease in their families, heredity is not yet a proven factor. The early forms are more common, and the lesions remain stable for a long time.

Efficacy of collagenase Clostridium histolyticum injection for Dupuytren's contracture in East-Asian population.

BACKGROUND: Treatment with injection of collagenase Clostridium histolyticum (CCH) has been recognized as an effective option for the Dupuytren's contracture (DC) in Europe and North America. However, there are no studies describing mid-term efficacy of CCH treatment in East-Asian population. The purpose of this study was to assess 2-year outcomes following CCH treatment in Japanese patients. METHODS: Twenty hands (28 joints) from 18 DC patients underwent CCH injection with manipulation according to the product specifications with 2-year follow-up. Patients were assessed for extension deficit on treated metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints before treatment, at 4 weeks and 2 years after the treatment. RESULTS: At 4 weeks after CCH treatment, contracture of treated joints significantly improved from the mean extension deficit of 45° before treatment to 3° for MCP joints, and from 41° to 14° for PIP joints (P < 0.001, <0.001, respectively). Improved contracture was maintained with 4° and 23° at 2 years after CCH treatment (P < 0.001, <0.05, respectively). Successful correction defined as ≤ 5° extension deficit was obtained in 14/16 MCP and 5/12 PIP joints at 4 weeks; of these, 11 MCP and 1 PIP joints maintained the corrected range of motion at 2-year follow-up. CONCLUSION: CCH treatment could be a useful option to improve contracture in Japanese patients. During 2-year follow-up, this treatment could provide comparable effect durability to previous studies from Western countries. Moreover, our results support the evidence that better correction of the contracture can be obtained in the MCP joints than PIP joints after CCH treatment.

Long-term follow-up of Dupuytren disease after injection of triamcinolone acetonide in Chinese patients in Taiwan.

Injection of triamcinolone acetonide is a non-operative treatment for early-stage Dupuytren disease in Caucasians, but its effectiveness in non-Caucasians is unclear. We report averaged 5-year follow-up results of 37 patients (49 affected hands) with early-stage Dupuytren disease for patients in Taiwan (non-Caucasian) who received a single dose of 5 mg triamcinolone acetonide injection into nodules monthly for 3 months. Using ultrasound, we recorded no progression of sizes of the modules following injection after 6 months. After an average 5-year follow-up, two patients with three hands (6%) experienced reactivation of the treated nodules. None required surgical intervention. Ultrasound examination showed that sizes of the treated Dupuytren nodules decreased significantly by 40% 6 months after injection and 56% at the final follow-up. We conclude that in these Chinese patients in Taiwan with early Dupuytren nodules, triamcinolone acetonide injection was effective in reducing the size of the Dupuytren nodules and maintaining long-term durable control of the nodular growth. LEVEL OF EVIDENCE: III.

Dupuytren's disease in the Hispanic population: a 10-year retrospective review.

BACKGROUND: Dupuytren's disease is a common benign fibroproliferative disorder of the hand. Epidemiologic studies have reported significant variation in disease prevalence among races, focusing primarily on those of northern European descent. In contrast, Dupuytren's disease in the Hispanic population has received little attention. Thus, in this study, the authors aimed to determine the prevalence and operative rate of Dupuytren's disease in the Hispanic, black, white, Asian, Native American, and other races and to characterize the disease presentation in Hispanics who required surgical treatment. METHODS: A retrospective review was conducted to identify the racial distribution of Dupuytren's disease patients seen at Bellevue Hospital between July of 2000 and August of 2010. In Hispanic patients requiring surgical treatment for their disease, data were collected on the following parameters: age, sex, ethnicity, hand dominance, hand affected, and digits operated on. Epidemiologic factors including smoking, alcoholism, diabetes mellitus, hypercholesterolemia, epilepsy, and hypertension were also evaluated. RESULTS: Dupuytren's disease prevalence was found to be 533 per 100,000 in Hispanics. Of these patients, 1.8 percent required surgical treatment, and this group was characterized by the following comorbidities: smoking (57.1 percent), hypertension (57.1 percent), alcoholism (52.4 percent), diabetes mellitus (47.6 percent), and hypercholesterolemia (19.0 percent). CONCLUSIONS: The authors' results indicate that Dupuytren's disease is more prevalent in the Hispanic population than previously reported. Although the epidemiologic factors identified in Hispanics with Dupuytren's disease are similar to those in other races investigated, there are important differences with respect to clinical presentation and surgical treatment.

Dupuytren's palmar contracture in women.

BACKGROUND: Dupuytren's disease is a fibroproliferative disorder of the palmar fascia that can cause disabling digital contractures. The pathogensis of the disease is still unclear, and it afflicts predominantly white males of northern European origin. Gender-related differences of Dupuytren's disease and the distinctive characteristics of the disease in females are not yet well defined. OBJECTIVES: To evaluate and illustrate the distinctive characteristics of Dupuytren's disease in females. METHODS: A retrospective study was performed of all female patients with Dupuytren's disease seen and followed at our Hand Surgery Unit over a 20 year period. The study group consisted of 48 women (56 hands). The collected data included clinical and epidemiological features on admission, and outcome of surgical intervention. RESULTS: Of the 48 women (56 hands) with Dupuytren's disease, 23 (26 hands) underwent limited fasciectomy. The average age at presentation was 60.1 years. A few of the patients originated from Asia and Africa. Manifestations and pattern of the disease were nearly comparable to those observed in the male group, except for a slightly higher incidence of proximal interphalangeal joint contracture in female patients. Generally, females expressed less severe contractures on presentation and a slower progression thereafter. A favorable functional postoperative outcome was observed. Seven patients had minor complications including local hematoma and painful scars. Two patients developed moderate signs of complex regional pain syndrome. CONCLUSIONS: Further investigations are needed to assess the potential role of androgens in the pathogenesis of Dupuytren's disease, and a possible protective role of estrogenic hormones, rendering Dupuytren's contracture a postmenopausal affliction.

Dupuytren's disease in Bosnia and Herzegovina. An epidemiological study.

BACKGROUND: It is generally held that Dupuytren's disease is more common in northern than in southern Europe, but there are very few studies from southern European countries. METHODS: We examined the hands of 1207 men and women over the age of 50 years in Bosnia and Herzegovina. RESULTS: The prevalence of Dupuytren's disease was highly age-dependent, ranging from 17% for men between 50-59 years to 60% in the oldest men. The prevalence among women was lower. The great majority only had palmar changes without contracture of the digit. The prevalence was significantly lower among Bosnian Muslim men than among Bosnian Croat and Serbian men and significantly increased among diabetics. No association could be detected between Dupuytren's disease and smoking, alcohol consumption or living in rural or urban areas. CONCLUSION: We conclude that, contrary to previous opinion, Dupuytren's disease is common in Bosnia and Herzegovina.

The prevalence of Dupuytren's disease among 2 different ethnic groups in northern Norway.

Dupuytren's disease is common in Norway and northern Europe but rare in individuals who are not of European descent. The aboriginal Sami of the northernmost parts of Scandinavia are ethnically distinct from most Norwegians. The occurrence of Dupuytren's contracture is unknown among the Sami. Data were collected on 456 individuals older than 50 years who were living in an area 750 km north of the arctic circle. Dupuytren's disease was found in 31 men and 3 women. The prevalence was lower among Sami than Norwegian men of all ages. The prevalence of having a grandson with Dupuytren's disease was also lower among Sami than Norwegian grandparents. Although none of the differences reached statistical significance, the results show that the prevalence is not very low among Sami men but probably lower than among ethnic Norwegians living in the same area, confirming the importance of a genetic disposition to the disease.

Bilateral Dupuytren's contracture in a black patient.

The first case of Dupuytren's contracture in a black patient with no obvious caucasian admixture was reported in 1979. This condition is rare in the purely black population and since 1979 only 23 cases have been reported. We present the case of a black man with no history of caucasian admixture with bilateral Dupuytren's contracture. We suggest that this condition may not be as rare as the literature suggests and, that canvassing other hand societies for their experience, particularly in the continent of Africa, may help to establish the true incidence of this condition.

Racial distribution of Dupuytren's disease in Department of Veterans Affairs patients.

Dupuytren's disease is a polyclonal fibroproliferative disorder of the palmar fascia of unclear pathogenesis. It has been described as a disease of northern European men and is reportedly rare in other races. A 10-year retrospective study using the Department of Veterans Affairs computer system was conducted to determine the racial distribution of this disorder among patients treated at all Department of Veterans Affairs medical centers. The study also determined demographic and clinical characteristics of black veterans treated for the condition at department medical centers. There were 9938 patients identified between the fiscal years of 1986 and 1995, of whom 412 were black (estimated prevalence of 130 per 100,000 population), 9071 were white (734 per 100,000), 234 were Hispanic white (237 per 100,000), 11 were Native American (144 per 100,000), 8 were Asian (67 per 100,000), and 202 were of unknown race. The characteristics of the disease in blacks are similar to those in whites. In both groups, the disease has a late onset, affects predominantly the ulnar digits, and is associated with other medical conditions, such as alcoholism, smoking, and diabetes. Unlike Dupuytren's disease in whites, however, the disease is rarely bilateral in blacks. The differential prevalence among racial groups suggests a genetic component to the pathogenesis of the disease.

Epidemiology of Dupuytren's disease.

Studying the epidemiology of Dupuytren's disease allows the identification of populations at risk and may point to inferences regarding etiology. Data suggest the highest prevalence of the disease occurs in people of northern European stock. However, the disease does occur in nearly all populations examined. Dupuytren's disease occurs more frequently in men than women and becomes symptomatic approximately 10 years earlier in the lives of men than in women. Dupuytren's disease has been associated with a number of other diseases including seizure disorders, alcoholism, diabetes mellitus, and cigarette smoking. There is conflicting evidence as to whether manual labor or HIV seropositivity increases the prevalence of the disorder.

Dupuytren's disease in African-Americans.

Seventeen African-American patients were operated on for Dupuytren's contracture over a 14-year period. Six-month minimum follow-up was available for 16 patients. The initial deformity, and results of surgical release of Dupuytren's contracture in this population was similar to that described in North Europeans.

Dupuytren's contracture in the black population: a case report and review of the literature.

A case report of a 34-year-old black man with Dupuytren's contracture of his left small finger and review of the literature of Dupuytren's disease in the black population is presented. A high incidence of trauma (54%) was associated with these cases.

Dupuytren's disease among the Chinese in Taiwan.

A retrospective study was made of 41 cases of Dupuytren's disease observed from 1970 to 1988 at the Veterans General Hospital-Taipei, Taiwan. The patients' ages ranged from 49 to 78 years; 21 patients had only one hand involved; 20 patients showed bilateral involvement. Thirty-three of 35 diseased hands with contracture were treated by regional fasciectomy. A follow-up study was done in 32 hands. The operative results of 30 hands were rated as good (94%); 3 showed extension of the disease and 1 had evidence of recurrence. Treatment was not given to 26 hands without contracture; 14 of these showed no change in the lesions, 3 improved, and 6 were worse when seen on subsequent visits. Seventeen of 33 excised thickened palmar fasciae contained nodules. All histological sections of nodule-free specimens showed dense connective tissues. Based on the fibroblastic activity and the amount of collagen, three easily discernible features of the histological make-up of the nodules were found.

Dupuytren's disease in patients from the Indian sub-continent. Report of ten cases.

We report on ten patients from the Indian sub-continent operated on in our unit for Dupuytren's contracture. Their presentation, operative findings and subsequent course was indistinguishable from Caucasian patients. We believe that Dupuytren's disease among Indians is not so rare as previously thought.

Dupuytren's disease in blacks.

Dupuytren's disease in blacks is believed to be rare. Our recent experience with the disease at the John Cochran Veterans Administration Hospital in St Louis is described, including 2 black patients suffering from the condition. The literature is reviewed and some aspects of pathogenesis are discussed. It is our belief that Dupuytren's disease is more common in blacks than previously reported.