WORLD WIDE DUPUYTREN'S CONTRACTURE SUPPORT
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No. All the evidence points to an earlier onset in men, who tend to get the disease about a decade earlier than women. The older the cohort, however, the more the proportion of men and women becomes equal, until with very old people about as many women as men have palmar or plantar fibromatosis.
You may be interested by the clear progress of understanding demonstrated by the following list of quotations about Dupuytren's disease. Each of them is taken from the medical literature.
- I have seen no true case in a female. - Mr. Keen 1877
- I have never seen it in women. - William Adams 1878
- This condition is never met with in women. - Dr. Myrtle 1881
- This curious affection is doubtless of very rare occurrence in the female sex but is not altogether unknown. I have at the present time an unmarried lady under my care who is in her eighty-ninth year, the fingers of whose right hand began contracting about two years ago. I am, moreover, informed that one of this lady's sisters, who died at the age of seventy, suffered from a similar contraction of the fingers of the right hand. - T.A. Carter 1881
- This affection very rarely occurs in women. - William Adams 1882
- Among 440 women were found 15 cases of indurated, thickened, and contracted fascia alone, and also 11 cases of well-marked Dupuytren's contracture of the fingers. - Mr. Noble Smith 1884
- [I have] seen six and operated on four [cases in women]. But I still considered it roughly true that the disease is ten times as common among men as among women. - Mr. Keen 1884
1900-1950s
- The disease occurs in men much more frequently than in women. I found 57 cases of Dupuytren's contracture among 270 old men, or 21%, and only 3 cases among 168 old women, or 1.8%. Dr. Noble Smith found 55 cases of the disease among 300 men, that is 18.3%, and 15 cases among 400 women, that is 3.75%. - Kenneth Black 1915
- Sprogis (1926) traced Dupuytren's contracture through three generations of a certain family, and found 17 cases among 53 persons, only 2 of which occurred in women. - Davis and Finesilver 1932
- The condition occurs mainly in men, only 15% of the patients being women. - Anon 1949
- This series of 22 cases of Dupuytren's contracture included 12 men and 10 women. A trend but no conclusive evidence may be noted from this small series of cases. The trend indicates that sex in itself has very little bearing on the etiology of this condition. - Charles LeRoy Steinberg 1951
- The low incidence in women deserves further study. Most cases in women occur after the menopause. A study of this disease and its relation to ovarian function would be important. - Joseph Boyes 1954
- Dupuytren’s contracture has often been thought to be a disease predominantly of men, as evidenced by surveys of previous series which gives a total ratio of 7:1. Our total series consisted of 43% female and 57% male patients. Of the entire group of 175 patients with Dupuytren’s contracture, fifty-one were females, thus giving a ratio of 3:1. - Yost, Winters and Fett 1955
1960-1990s
- The known facts, however, are quite clear-cut. It is a disease predominantly of men, although a few women do get it. - A.R. Wakefield 1960
- No significant sex difference is present in the incidence of Dupuytren's contracture in subjects over 40 years. In the group aged 39 years and under, a 5.05% incidence was found in 594 males, and a 2.55% incidence in 157 females. Dupuytren’s contracture occurs in women almost as frequently as in men. Previous estimates of an incidence in females of 10% to 20% of that in males (Kanavel Koeh and Mason, 1929), have been based on figures derived from operation statistics which do not give a true indication of the incidence in the general population. - John Hueston 1960
- Dupuytren’s contracture affects men seven times more often than women, but it is not rare in women. In women the results of surgery may be most disappointing; post-operative function is very variable and the tragedy of the " frozen" hand sometimes occurs. Poor results are apparently seen more often in women than in men, but no analysis has, to the writer's knowledge, been published. - Antony Wallace 1964
- It is seen more often in men than in women, especially in the younger age groups. - Su and Patek
1970-1980s
- It is a disease of dominant inheritance expressed more commonly and earlier in men than in women. - Honner, Lamb and James 1971
- The disease was detected in 9.4% of the 6888 men and 2.8% of the 9062 women. The prevalence among men rose from 0.2% in the 20-24-year class to a maximum of 36.8% at 70-74 years, and then declined. For the women the prevalence rose from 0.3% for the 40-44-year class to a maximum of 25% at 80-84 years, after which it diminished. The ratio of men to women was infinite in the youngest classes but fell almost hyperbolically to 1.2 in the oldest group. - Otto A. Mikkelsen 1972
- It is more common in men than women. - Fisk 1974
- A man of 45 has a 59% chance of having Dupuytren's already if he is destined to develop it, a woman of the same age, only 17%. - J.I.P. James 1974
- At corresponding ages, the contracture is more severe in men than in women, and more severe in the right than in the left hand. - Mikkelsen 1976
- While the assertion of some 19th-century authors that the condition does not occur in women is clearly wrong, there is certainly no doubt that it is far more common in males than females. - Phillip Matthews 1979
- Of the 919 patients examined, twenty-one men (5%) and fifteen women (3.5%) showed evidence of Dupuytren's contracture. The average age of the affected men was 59 years (29-75 years) and of the women 63 years (39-81) years). - R. P. Mackenney 1983
- Women are afflicted only half as frequently as men when the incidence in a general population is studied. When, however, operation statistics have been used to compare sex incidence, women are found to constitute only one in eight or one in ten of those undergoing surgery. This lower incidence of surgery in women may depend on a slower evolution of the condition to a degree of disabling deformity or merely reflect a greater tolerance of the deformity by women. - John Hueston 1984
2000 to today
- The average age of onset in men is about 48 years, while in women it is 59 years. Although the disease appears later in women, and is usually less severe, the postoperative complication of chronic regional pain syndrome is double that of men. - Boscheinen-Morrin and Conolly 2000
- Men typically present earlier (mean age 55 years) than women (10 years later) and have more severe disease. - Townley, Baker, Sheppard and Grobbelaar 2006
- Commonly occurring in adults in their 40s to 60s, Dupuytren contracture occurs 10 times more frequently in men than in women. - James H. Calandruccio 2007
- The mean age of onset of the disease [among 60 women] was 50 years and 6 months. Dupuytren’s disease is more uncommon in women and in general, a male-to-female ratio of 5:1 is seen. Although surgical outcome appears to be comparable in men and women, the disease tends to flare up [recur?] more frequently in women. - Degreef, Steeno and De Smet 2008
- Only a few reports in the literature address gender-related differences in terms of incidence, presentation, natural history, and outcome of surgical intervention. The distinctive characteristics of the disease in females are not yet well defined. - Stahl and Calif 2008.
Yes. You are more likely to get it than someone who does not have your disease. The likelihood that you will get the other disease at some point goes up as you age. The probability is not known but is probably greater than 50-50. Having Dupuytren's disease also makes it more likely that you will develop Garrod’s pads (knuckle pads).
If you are male, having either DD or LD is a risk factor for developing Peyronie’s disease.
Your risk of getting one of these diseases is greater than average if you:
- are of European descent (perhaps particularly Northern European)
- are older than 40, and the older you are, the higher the risk that you will develop one of them
- have a relative with the disease
- have Ledderhose, Garrod’s pads or Dupuytren's disease already
- have Peyronie's disease
- have ever had a frozen shoulder (adhesive capsulitis)
- habitually drink the equivalent of a bottle of wine a day and have done so for several years. The more you drink, the greater the risk.
- are male (though the main sex-related difference in risk seems to be that the onset of the disease tends to be about 10 years later in women than in men)
- have insulin-dependent diabetes (and particularly if you are taking insulin or oral hypoglycaemics for diabetes). Diabetic patients tend to have a lower diathesis (that is, a milder form of the disease).
Researchers have suggested a large number of other risk factors, but others have contested them. This list includes cancer, epilepsy (particularly if you are controlling it with phenytoin or phenobarbitone), high cholesterol, heart disease, hypo- and hyperthyroidism, and low body weight and body mass index.
Chronic liver disease is sometimes cited as a risk factor, but the balance of the evidence from several studies suggests that this is unlikely, when heavy drinking is accounted for.
Although some studies provide contrary evidence, heavy smoking seems, on balance, to be a strong risk factor, independent of the link between heavy smoking and heavy drinking.
Risk factors only increase the risk of getting the disease. It is conceivable, although improbable, that a teetotaling young woman of African descent could develop one of the diseases. But if she did, we could infer that at least one of her ancestors came from a group whose gene pool included alleles linked to the appearance of superficial fibromatosis.
Several studies suggest if you carry the genes for the disease, then trauma to the hand or wrist (or foot or ankle in the case of Ledderhose disease) can provoke the disease. Where an injury is thought to have provoked the disease, it typically took place years before the disease appeared.
The link between trauma and the appearance of Dupuytren's disease is difficult to prove, since many people have injured their hands or feet at some point in their lives, and it is not at all clear that a particular injury triggered the disease.
By analogy, we can be certain that many people developed a migraine sometime in the decade after they read “War and Peace”. If they claim that the book gave them the migraine, we might have our doubts – first, many people who read the book did not get a migraine, and many people with migraines have never read the book. But it is still possible that reading “War and Peace” did indeed give some individuals a migraine. If we found that readers of “War and Peace” were more likely to get migraines than people who had not read it, we would want to know whether people who are predisposed to migraines are also predisposed to reading daunting books by 19th-century Russian authors.
Back to Dupuytren's and Ledderhose disease; there is some evidence that people with Dupuytren's disease are more likely to have had (or at least to remember) trauma to their hands (often several years earlier) than people who do not have the disease. Unfortunately, we do not know whether people who have injured their hands are more likely to develop the disease.
In conclusion, while it is not necessary for you to hurt your hand or foot to trigger the disease, there is an increasing body of evidence to show that trauma does sometimes trigger it.
If a trauma triggered the appearance of the disease, it did so because the genetic conditions made it possible for a normal healing process to run out of control. While another trauma could possibly trigger the appearance of the disease in a hand or foot, unfortunately, it seems that no such trigger is needed.
Many people get the disease without having injured themselves or used vibrating equipment.
So yes, another trauma could trigger the disease in another place, but it may not wait for that.
A growing body of evidence suggests that the use of vibrating tools for at least 2 hours a day for many years, is a risk factor for Dupuytren's disease.
For example, in 2012 Professor Alexis Descatha and his co-workers looked at the 13587 employees of Electricité de France (EDF) and Gaz de France (GDF) who answered a questionnaire on their health. Of these 10017 men and 3570 women, 839 men and 160 women said that they had Dupuytren’s disease. (Descatha A, Bodin J, Ha C, Goubault P, Lebreton M, Chastang JF, Imbernon E, Leclerc A, Goldberg M, Roquelaure Y. Heavy manual work, exposure to vibration and Dupuytren's disease? Results of a surveillance program for musculoskeletal disorders. Occup Environ Med. 2012 Apr;69(4):296-9. doi: 10.1136/oemed-2011-100319. Epub 2012 Jan 2.)
The study looked at a variety of potential risk factors for Dupuytren’s disease. The only significant link was with people who had had “high cumulative occupational exposure to vibration (intensity x duration)” from tools that transmitted vibration to the hands. This included “screw tools, common drills and (infrequently) pneumatic drills, where strenuous hand grip increases vibration damage”.
They found no relationship between Dupuytren’s disease and jobs that involved carrying loads.
Other studies have, however, detected an increase in the likelihood of developing Dupuytren's disease and heavy manual labour.
The pieces of this puzzle will slowly fall into place as more evidence comes in. At present, the link between heavy manual labour and Dupuytren's disease is not clear cut, not least because the disease does not correlate with handedness and seems to develop in either palm irrespective of which hand is dominant.
Unfortunately employers and their insurance companies have a clear vested interest in determining that Dupuytren's disease is not an occupational disease. This means that science is likely to be politicised.
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Contact information provided below for radiation oncologists who have treated for Dupuytren's Contracture or Ledderhose . Comments or opinions expressed here or on DART are not intended to diagnose or prevent disease. Advice or comments should not be relied upon unless confirmed by your treating physician. No doctor-patient relationship is intended and members are advised to consult their doctors for medical advice. No representation is made about the quality or professional competency of the listed doctors. This listing provided as a place for you to begin your own research. If you find the contact info outdated or in error, please comment on DART where it can be corrected. You might also google the doctor or clinic to find updated contact information. Many of these doctors also practice at secondary locations that may be closer to you. Check their website. In addition to their clinical practice, many of these radoncs are also on the faculty of local medical schools where they teach radiation oncology. If you have doctor or clinic information not listed below, please share with DART so it can be made available to others looking for treatment in that location. some photos from dupuytrens.org Thank you.
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