How does a Dupuytren nodule form on the palm?

Dupuytren nodules and cords are different

Dupuytren nodule formation, the first sign of Dupuytren contracture, usually affects males 50 years and over, especially those of northern European descent.  Although the size and shape are variable they are usually range in size from a dime to a quarter, although they can be smaller and larger than this.   Typically a person will first notice a small bump or lump on the palm that increases over time.

Dupuytren nodules are different from other connective tissues of the palm at the cellular level in two ways:  there is an increased activity and growth of two types of connective tissue cells called the fibroblast and myofibroblast; there is greater production of a connective tissue protein called collagen.  As these fibroblasts and collagen are laid down in the palm of the hand, it causes first nodule formation, and later Dupuytren cord formation.  The presence of these two structures is associated with progressive thickening, puckering and adherence to the skin, resulting in palmar fascial contractures and later flexion of the involved finger(s) under the skin of the palm (specifically, the pre-tendinous bands of the palmar fascia).

Dupuytren nodules are different from Dupuytren cords at the cellular level in that there are fewer myofibroblasts and fibroblasts in the cord, and they are irregularly scattered in all directions in the nodules they are in a distinctly parallel pattern in the cord.

The most common site for these palm lumps is at the base of the 4th (ring) and 5th little) fingers.  The Dupuytren nodule at first can resemble a common callus and is often painless, unless touched; occasionally the pain is more significant and lasts for some long while.

Dupuytren lump on the palm

What triggers the Dupuytren lump on the palm nodules to form is still a medical mystery, but seems to be related to liver disease, smoking, trauma and diabetes amongst a few lesser factors.

As the palmar tissue slowly thickens and tightens over months to years, it can develop into Dupuytren cords that flex the involved finger(s) down toward the palm of the hand.  In severe cases the Dupuytren nodules and cords can cause such marked finger(s) flexion that hand function is compromised for common activities of daily living (personal hygiene, dressing, opening a door, putting the hand into a pocket, etc.), so that the individual is functionally disabled.

The progress of Dupuytren nodule development is typically slow, unpredictable and sporadic, without detectible exciting factors.  As the disease progresses over time, the thickened and dense tissue infiltrates between and around normal tissue structures (tendons, ligaments, nerves, blood vessels).

While the medical profession (surgeons) commonly state that the primary treatment option for Dupuytren contracture is surgery to remove the nodule and cord formation, as well as contracted tissue around involved joints, a small but growing segment of the medical profession agrees that non-drug and non-surgical treatment is an effective option that should be attempted before resorting to the surgical route.

For more information how to reverse and eliminate, or at least reduce, Dupuytren nodules and cords see natural Dupuytren treatment.

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>> Dupuytren Contracture Treatment – FAQs


Do you know anything about santyl ointment?

do you know anything about santyl ointment?


Greetings Larry,

Santyl ointment is a petroleum based product containing collagenase that is formulated to debride (remove) necrotic (dead) tissue cells from burns, ulcers, gangrenous tissue and poorly healing wounds.   Much like maggots  were once (and currently on occasion still are) applied to selectively remove the dead tissue of a poorly responding wound to promote healing, the collagenase of santyl ointment is also used for this specific purpose.

I suppose it is because of the way this collagenase ointment is formulated that it is to be applied specifically only to dead tissue, and not healthy or living tissue.  This makes its use for Dupuytren treatment contraindicated, and is likely the reason it does not have FDA approval for Dupuytren use.  This is probably also the reason that the drug manufacturers have not attempted to market it as a Dupuytren disease treatment.

When it is applied carelessly or accidentally to normal tissue a reaction occurs in which localized inflammation develops, suggesting that the collagen of normal tissue is attacked by the collagenase of santyl ointment.   Given the nature of collagenase to indiscriminately disrupt collagen, prolonged use for Dupuytren cord or nodule treatment would result eventually result in an ulcer that would not heal because of the presence of collagenase.  For this reason the manufacturer of santyl ointment is careful to emphasize that it should only be applied to the dead tissue of a burn, ulcer, gangrene or poorly healing wound, not intact and viable skin.

Lastly, I have have checked the molecular weight of collagenase and I believe it is too large for it to be carried by DMSO through the tissue. TRH






Is Dupuytren’s Contracture in the arthritis family?

Dr. Herazy,

Is Dupuytren’s Contracture in the arthritis family? And, if it is, what vitamins should I be taking for the swelling and losing the use of my last two fingers.

Thank you.


No, Dupuytren contracture is not in the arthritis family.  By definition, an arthritis is an inflammation of a joint.  Joint inflammation and swelling are not the primary element of the problem of the excess collagen formation in the palm of the hand known as Dupuytren contracture.  While the joints of the finger might eventually become affected, it is a secondary complication.

Which vitamins to take is discussed at length on the DCI website.   You can begin your reading at Introduction to Natural Dupuytren Treatment.    The process of determining exactly which vitamins, minerals, enzymes or other external therapies to use is also discussed in that same section.   It is determined by monitoring the condition of the size, shape, density and adherence of the Dupuytren nodule to the deep fascia of the palm as you experiment with the therapies available on the DCI website.   TRH