New enzyme provides non-invasive fix to Dupuytren's contracture

It is a disease most people have never heard of and probably cannot begin to pronounce, but 3% of the US population has it.

It is a hand deformity that can make it impossible to straighten your fingers or even your toes.

It is a disease so old, it may date back all the way to the time of the Vikings.

Until now, urgery used to be the only way to fix it.

When Patrick Bergeron puts his hands to work, he can build almost anything. He has made a house and even an airplane that he has in his garage.

Patrick says, "I've made a living using my hands my whole life."

For 20 years, there were things his hands could not do, like picking up a jar.

"I couldn't use two fingers. I'd have to pick it up with three fingers."

He couldn’t reach in to get his keys.

"I couldn't get them in, couldn't get them in my pocket."

His x-rays tell the story. Patrick had Dupuytren’s contracture, a build up of collagen that forms thick bands, pulling in the third and fourth fingers on each hand.

Straightening the fingers used to mean invasive surgery and months of rehab, but Dr. Eric George introduced Patrick to a new option.

Day one: Dr. George injects an enzyme called Xiaflex at three points to dissolve that tough band in his finger.

Dr. George, a hand surgeon at Hand Surgical Associates, says, "That enzyme over a 25-hour period will basically erode or help to deteriorate this band

Twenty-four hours later, some local anesthetic and a little manipulating separates the tissue, and one big pop straightens Patrick’s finger for the first time in 20 years.

Now, after having all his fingers straightened, Patrick has got a lot more projects on his list and a lot less to worry about. He is a handy guy whose hands will not be a problem anymore.

"It's a miracle."

Dupuytren’s contracture is more common in men than women, especially in those of northern European descent.

Not all patients suffer symptoms severe enough to require medical intervention.

The new enzyme treatment is FDA-approved, but it is not pain-free.

The shots and the follow-up fix may cause discomfort, but unlike the surgical approach, once the enzyme fixes the problem, studies have shown it does not come back.

The enzyme procedure is usually covered by insurance.


BACKGROUND: Dupuytren's contracture is a localized formation of scar tissue beneath the skin of the palm of the hand. The scarring accumulates in a tissue (fascia) that normally covers the tendons that pull the fingers to grip. As Dupuytren's contracture progresses, more of the fascia becomes thickened and shortened. Dimpling and puckering of the skin over the area eventually occurs.

SYMPTOMS: Dupuytren's contracture typically progresses slowly over several years. Occasionally, it can develop over weeks or months. In some people, it progresses steadily, and in others, it may start and stop. Dupuytren's contracture usually begins as a thickening of the skin on the palm of the hand. As Dupuytren's contracture progresses, the skin on the palm of the hand may appear puckered or dimpled. A firm lump of tissue may form on the palm. This lump may be sensitive to the touch but usually isn't painful. In later stages of Dupuytren's contracture, cords of tissue form under the skin on the palm and may extend up to the fingers. As these cords tighten, the fingers may be pulled toward the palm, sometimes severely. The ring finger and pinky are most commonly affected, though the middle finger also may be involved. Only rarely are the thumb and index finger affected. Dupuytren's contracture can occur in both hands, though one hand is usually affected more severely than the other.
(SOURCE: Mayo Clinic)

CAUSES: The precise cause of Dupuytren's contracture is not known. However, it is known that it occurs more frequently in patients with diabetes mellitus, seizure disorders (epilepsy), and alcoholism.

REGULAR TREATMENT: If the disease progresses slowly, causes no pain and has little impact on your ability to use your hands for everyday tasks, you may not need treatment. Instead, you may choose to wait and see if Dupuytren's contracture progresses. Treatment involves removing or breaking apart the cords that are pulling the fingers in toward the palm. This can be done in several different ways. The choice of procedure depends on the severity of your symptoms and any other health problems you may have.
(SOURCE: Mayo Clinic)

NEW TREATMENT: The U.S. Food and Drug Administration approved Xiaflex (collagenase clostridium histolyticum) as the first drug to treat Dupuytren's contracture. Xiaflex is a biologic drug made from the protein product of a living organism. It works by breaking down the excessive buildup of collagen in the hand. This enzyme weakens the cord, which then, in a next step, can be pulled and mechanically broken. Bent fingers thus become straight and functional again. One of the early studies proposes enzyme injection as a safe and effective method as an alternative to surgical fasciectomy. The most common adverse reactions in patients treated with Xiaflex were fluid buildup, swelling, bleeding, and pain in the injected area.

Craig Henry, Practice Administrator
Hand Surgical Associates
Metairie, LA

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