Dupuytren’s disease, also known as Dupuytren’s contracture, affects millions of people across the world. Dupuytren’s disease is present in the genes of individuals affected since birth, but the disease generally develops between the ages of 40 and 50. It can affect only one hand, but often develops in both. For reasons unknown, men are more often affected than women.
Certain factors may worsen Dupuytren’s disease, such as diabetes, epilepsy, alcohol consumption or certain medications. Although generally painless, Dupuytren’s disease gradually becomes more severe. Activities or professions that cause microtrauma in the palm of the hand can also increase the progression of Dupuytren’s disease.
Dupuytren’s disease is defined as a retractile fibrosis of the palmar aponeurosis of the hand. The palmar aponeurosis is a membrane located between the flexor tendons and the skin of the hand. The disease is characterized by a gradual bending of certain fingers. In the long term, the hand contracts and remains in a flexed position. It becomes practically impossible to completely open the hand or fully extend the fingers on a flat surface. The little finger and ring finger are usually affected first.
Dupuytren’s disease also leads to the formation of one or several nodules in the palm of the hand. These are sometimes painful at first. Dupuytren’s disease makes it difficult to grasp objects, which may make daily activities more difficult.
How is Dupuytren's disease treated?
As of several years ago, surgery is no longer the only available option to treat Dupuytren’s disease.
For example, Xiaflex injections help relieve contractures in individuals with Dupuytren’s disease. Collagenase clostridium histolyticum, a prescription medication, is injected into the affected areas of the hand. This medication consists of collagenase enzymes that release contracture, which greatly improves hand function. Collagenase clostridium histolyticum has been used to treat this condition since 2010 in the United States and has been approved by Health Canada.
During the initial meeting with your surgeon, he will explain in detail the different options available to you and the benefits of collagenase clostridium histolyticum injections. The treatment is non-invasive, simple and effective.
Although there is no cure, the available treatments relieve symptoms by relaxing the finger contracture. The disease is chronic and progresses slowly. Revision surgery or additional collagenase clostridium histolyticum injections in the same finger or hand can be expected for patients with a more rapid or aggressive form of the disease. Additional collagenase clostridium histolyticum treatments pose fewer risks than surgery.
Notice : The Xiaflex was recently withdraw from the Canadian market by the US pharmaceutical company Endo for financial reasons. This drug is therefore no longer distributed in Canada.
It is possible to obtain it through special permission from Health Canada. However, the cost of purchase for the patient at the pharmacy is much higher than before, now approximately $8,500 CAD. An insurance company that reimbursed this drug before might continue to do so despite the higher costs. The fees for Xiaflex injections administered by your hand surgeon are still covered by the RAMQ.
Frequently asked questions
Collagenase clostridium histolyticum is a prescription medication used to treat adults with Dupuytren’s disease when one or several “cords” can be felt. The active ingredients in Xiaflex include a combination of two powerful collagenases produced by the Clostridium histolyticum bacteria. These enzymes work by breaking down the long chains of collagen found in the one or more cords keeping the fingers bent towards the palm of the hand.
Since it is not an invasive surgery, the risks of complications associated with collagenase clostridium histolyticum injections are minimal. When they do occur, complications are most often temporary.
The most frequent complication of a collagenase clostridium histolyticum injection is the presence of bruising at the injection site. This complication, which is usually local and mild, disappears within the days or weeks following treatment. It is also possible to develop swelling in the hand or discomfort at the injection sites. These side effects are temporary. If necessary, anti-inflammatories such as Advil may help reduce discomfort.
The procedure takes less than 15 minutes and you can return to your normal routine within days of the injections. The vast majority of patients only require a single treatment for each finger. However, more injections may be necessary. During treatment, your surgeon will administer a collagenase clostridium histolyticum injection in the affected palmar cord using a fine needle. A second meeting with your surgeon is needed during the first few days after the injection to extend the treated finger. This procedure, as well as the collagenase clostridium histolyticum injection, is usually performed under local anesthesia.
The Xiaflex manufacturer recommends a finger extension splint after finger manipulation. The splint is usually worn at night for several months following the Xiaflex treatment. A consultation with an occupational therapist specialized in hand therapy could therefore be suggested for a custom splint. However, the consultation with an occupational therapist in a private clinic is not covered by the RAMQ public plan.
PLASTIC AND AESTHETIC SURGEON
Dr. Mario Luc
Make an appointment with a surgeon
We would be glad to help you through the process by answering all your questions and allaying your concerns.