Dupuytren's disease: from the first signs to the most advanced stages.

Abstract

Dupuytren's disease is a benign fibroproliferative condition of the palmar fascia, characterized by onset of nodules that develop into cords causing irreducible digital contracture. Prevalence increases with age. It mainly affects males of Northern European origin. Etiopathogenesis is multifactorial, combining genetic predisposition and environmental factors such as alcohol consumption, smoking, microtrauma and diabetes. Management is based on precise clinical assessment, with Tubiana classification and diathesis screening, to adapt therapeutic strategy. In the early stages, monitoring may be combined with medical treatment (radiotherapy, collagenase, corticosteroids, anti-TNF) aimed at slowing progression. In case of functional impairment or significant retraction, several surgical options are available: percutaneous fasciotomy, limited or segmental fasciectomy, dermofasciectomy with skin grafting, or even phalangectomy in severe recurrent cases. This narrative review provides an up-to-date summary of epidemiological, pathophysiological and therapeutic data, emphasizing the importance of a decision-tree that takes account of the progression, diathesis and severity of the contracture.