Unfortunately, recent results presented at the Dupuytren's symposium 2012 at Leuven, Belgium, indicate that after 2 years the effect of tamoxifen already levels off, i. e. Chir. 21 (1989) p 66 - 71, English abstract, full paper in German) demonstrates that constricted veins (stenosis) of the arm can severely affect the healing process after operation. Also, we could not find any long term data, very little on side effects and nothing on recurrence. This treatment is subject to a and has not yet been approved by the FDA. Using not the usual low energy radial shock waves but high energy focussed shock waves, a randomized trial had been performed inj 2011/12 at the German Medical University Hanover to treat Dupuytren's disease. J ). As no clinical data have been published yet (and probably won't be published because Juergen Kopp has moved on to another clinic and assignment) Dupuytren Society as an inital assessment collected data from patients who have taken or are taking NAC. For results see. For more details on NAC, including brand names, see. In high-risk, aggressive cases Tamoxifen has been tried in combination with segmental surgery. A patient reported that his Dupuytren nodules significantly decreased when he eat excessive amounts of tomatoes during the harvest period.
Plast. First results on a few patients have been reported in 2012 at the annual meeting of the German hand surgeons. A paper by A. Belaguer at al. Histological Staging And Dupuytren's Disease Recurrence or Extension after Surgical Treatment: Suggest a high intake of antioxidants, e. g. Eur. 2009 Apr 24. More recently O Donaldson, winner of the 2011, analysed Results show pain reduction for some aptients but other patients reported no effect. A 20-Year Review of the English Literature. Possible side effects of which we have heard (or experienced ourselves) include: Actually some of the above side effects may be predictable. Effectiveness and long term effects need still to be researched and we would caution taking high dose antioxidants like NAC over a long period of time, like years (see e. g. This can result in edema or a hand-finger-syndrome, including the inability to make a fist. Histological staging might help predicting recurrence and extension of the disease after surgery, see T. G. It is important that for patients with contracture the injection might bring some relief and increased range of motion but patients might still require surgery or NA to fully release the affected finger. Private communication, not published).
To better judge the effect of high energy focussed shock waves for Dupuytren's disease a higher number of cases and a better unterstanding of long-term sustainability and side effects are required. Above study is a laboratory study on Dupuytren cells, not a clinical study on patients. To avoid extension of Dupuytren to other areas after surgery or, in one case, a significant reduction of Ledderhose nodules. Should this turn out a successful therapy it might eventually support other therapies. While the total number of patients is still too low for reliable statistics, first results seem promising, e. g. Wilhelm and D. Similarly, taking seems to reduce growth rates and soften cords. So far reports of successful diets provide only anecdotal evidence, no sound statistics and no comparison to control groups. Since publication of this study NAC has also been tested on patients (orally applied, typically 600 mg/day; Patients should also be aware that individuals may respond very differently to diets, making general diet recommendations diffcult if not dubious. H. Herweijer et al. Postoperative hand therapy in Dupuytren's disease (Disabil Rehabil. 2007 Nov 30; 29(22): 1736-41 ). Given the lack of differences in outcomes between patients correctly referred and patients incorrectly not referred, postoperative hand therapy in Dupuytren's disease should be reconsidered.
We therefore consider diets as experimental and remind patients that diets may have severe side effects. Some patients report successful reduction of Dupuytren nodules after 6 months of vegetarian, no alcohol, no coffee diet. Other diets e. Mikrochir. This study will continue to check for effects on recurrence (see also ).
Yet this study indicates the possibility of NAC providing a basis for a therapeutic strategy in Dupuytren's disease and other fibroproliferative disorders. A Retrospective Study of 124 Patients Cell 163(5): 1079 1094). Side effects are unfortunately not unlikely: The survey of 990 operations by McFarlane (1983) in a multi-centric study, best illustrates the frequency of serious complications following today's most popular operations: More recently an overview of Early Postoperative Complications was compiled by Keith Denkler Surgical Complications Associated With Fasciectomy for Dupuytren's Disease: The effect might be due to the high lycopene (antioxidant) content of tomatoes. A randomized trial showed improved results of the surgical outcome when Tamoxifen was applied as adjuvant oral therapy. This has been demonstrated for blood glucose levels (D Zeevi et al. (2015) Personalized Nutrition by Prediction of Glycemic Responses. The association between intraoperative correction of Dupuytren's disease and residual postoperative contracture The Journal of Hand Surgery (European Volume, 2010) 35E: 3: 220 223. It might be worth noting that a comparison of a postoperatively treated group of patients with a not treated group did not reveal significant differences. Wolfgang Lutz' Living without Bread ). An overall complication rate of 19% and loss of flexion and algo-neuro-dystrophy occurring alone or together in 10% of patients. (cited from Thesis Moermans, 1997 ). Englert on The Significance of the Subclavian Vein Stenosis in the Treatment of Dupuytren's Disease (Handchir. J Hand Surg. There is no long-term benefit. Also proposed are low or zero carbohydrate diets (e. g. Thesis dupuytren.