Aetiology

Dupuytren's contracture is associated with:

• manual labour (1)
  • uncertainty around the association between Dupuytren's disease and manual labour, in particular the use of vibrating tools
    • many authors have linked repetitive hand trauma associated with certain occupations to the development of Dupuytren's disease, but a study evidence of the patterns of disease in miners did not find a statistically significant correlation between the two (2)
• hand trauma
  • most experts would concede, however, that a one-off hand injury can rarely trigger Dupuytren's disease and that a history of manual labour indicates a worse prognosis (1)
• epilepsy / treatment with phenobarbitone or phenytoin (1)
  • controversy exists as to the significance of either anticonvulsant drugs or epilepsy (1)
  • link between Dupuytren's disease and epilepsy remains unclear, although latest evidence suggests that the association may be due to the effect of certain antiepileptic medications (2)
• Peyronie's disease
• smoking and excessive alcohol intake are independent risk factors for disease development
  • in both cases the relation is dose dependent (odds ratio 1.5-2 for smoking and 1.35-4.2 for alcohol) (1)
• chronic liver disease is not a risk factor independent of alcohol consumption
• a family history of Dupuytren's contracture
  • there is a strong genetic association with study evidence showing up to an 80% heritability (2)
• trauma
• myxoedema
• diabetes mellitus
  • more prevalent among people with diabetes, especially those dependent on insulin
  • diabetic patients tend to have a milder form of the disease
• hypercholesterolaemia (1)
  • patients with Dupuytren's disease have also been noted to have raised serum lipids compared with controls
• AIDS

It may also be idiopathic.

Development of Dupuytren's contracture may result from the disturbed metabolism of oxygen-derived free radicals causing fibroblast proliferation and palmar fibrosis.

Reference:

1. Townley WA et al. Dupuytren's contracture unfolded. BMJ 2006;332; 397-400.
2. Karbowiak M et al. Dupuytren's disease. BMJ 2021;373:n1308