Dupuytren's contracture - treatment without surgery. Options for preparing a healing ointment. Causes of contracture

Dupuytren's contracture is a painless disease. You can suspect it if nodules, compactions and cords appear under the skin of the palm. The fingers that are tied with them, and most often it is the little finger and/or ring finger, are difficult to straighten. In particularly difficult cases, the affected fingers do not straighten at all. Their sensitivity decreases. Often this disease affects both hands at once.

Sometimes the disease also affects the legs. The ligaments in your feet become inflamed and thickened, a condition called plantar fasciitis.

Description

Dupuytren's contracture is a fairly common disease and has been known for a long time. The first mention of it was found in the works of the Swiss physician Felix Platter in 1614. 150 years after him, this disease was studied by the French surgeon Guillaume Dupuytren, after whom it was named.

Men are more likely to suffer from Dupuytren's contracture than women, with people in Eastern Europe, Scandinavia and Ireland being most susceptible to the condition. Young people rarely suffer from Dupuytren's contracture; this disease mainly affects people aged 40-60 years. In most cases, the disease affects the palmar surface, but Dupuytren described cases of the development of this disease on the soles, and even in the cavernous body of the penis.

The exact cause of the disease is unknown. However, it is assumed that it occurs due to overload of the hands, metabolic disorders, or due to some kind of inflammation. Often this disease develops in people suffering from diabetes, epilepsy and alcoholism. One of the likely causes of the development of this disease is smoking. The hereditary nature of the disease cannot be ruled out, since it is known that if one of the family members has Dupuytren's contracture, and later this disease begins in another family member, then it develops faster and proceeds with more serious complications.

In those suffering from Dupuytren's contracture, cicatricial degeneration of the palmar aponeurosis (a plate of connective tissue located under the skin) occurs. That is, the connective tissue is replaced by scar tissue. There are three stages of the disease:

• Stage I - the fingers move normally, but nodules and cords appear on the palm;
• Stage II - fingers are pulled together with cords and bent at an angle of 90°;
• Stage III - the fingers are bent at an angle of more than 90°, they move poorly, their sensitivity is reduced, the skin on the palms looks like parchment and cracks.

According to location, palmar form, finger form and mixed form are distinguished.

Diagnostics

For correct diagnosis For this disease, it is necessary to listen to the patient’s complaints, find out about his lifestyle, and palpate the hand. On palpation, the doctor feels thickening of the palmar fascia (a sheath of connective tissue that forms a “case” for the muscles) in the form of cords and nodules. Moreover, at the beginning of the disease, these nodules are located only on the palms, and then, in later stages, they can be found on the affected fingers. An x-ray of the hand is also taken.

The next stage of diagnosing Dupuytren's contracture is assessing the amplitude of flexion and extension of the fingers - with this disease, the extension of one or more fingers is difficult. And if the disease has gone far, it is almost impossible to straighten them out.

Additional tests are not required to diagnose this disease.

It is necessary to differentiate this disease from tumors of the hand and tenosynovitis (inflammation of the tendon sheaths).

Treatment

There are conservative and surgical methods for treating Dupuytren's contracture. The choice of method depends on the stage and complexity of the disease.

Conservative treatment methods are effective in the initial stages of the disease. Doctors prescribe massage, physical therapy, if there is no inflammation, exercises to stretch the palmar fascia. Splint bandages are recommended during sleep. Sometimes they also prescribe drug treatment- for local inflammation, injections of corticosteroid drugs are effective.

If the patient experiences pain, he is prescribed a blockade - an anesthetic and glucocorticoid hormone are injected into the area of ​​the connective tissue nodule. These drugs relieve pain, the effect of such a blockade lasts 6-8 weeks.

But in most cases, conservative therapy can only slow down the development of the disease. Therefore, after some time the patient will still need surgery. The operation involves removing scar tissue. Moreover, you don’t have to cut your palm to do this. In the initial stages, the nodules can be removed with a needle. This procedure is called aponeurotomy. Surgery is recommended if the angle between the fingers and palm is less than 30°.

Treatment with shock wave therapy is also possible. This is a painless procedure in which the device generates a wave that is directed to the site of the disease, causing positive changes in the affected tissue.

In some cases, a fixed joint is formed so that the fingers cannot bend at all. And in very severe cases, when overgrown connective tissue compresses blood vessels and nerves, finger amputation is indicated.

Prevention

Since the exact cause of the disease is unknown, there is no prevention. But doctors recommend promptly eliminating the consequences of microtraumas to the hand and wearing protective gloves.

Doctor Peter

FAQ: What complications are possible after surgery to eliminate Dupuytren's contracture?

During the operation, scar tissue that has formed under the skin of the palm is removed. However, there is a chance that scar tissue will form again after surgery. Nerve injuries may also occur during surgery.

FAQ: How is recovery after surgery?

Usually the patient is sent home after the operation on the same day. However, the rehabilitation period depends on the stage of the disease. Full recovery at early stages The disease takes about a week, but it is necessary to limit the load on the arm. In severe cases, recovery may take several weeks. Sometimes after surgery it is necessary to wear a special splint.

Read about treatment without surgery for Dupuytren's contracture. About 3% of the world's population suffers from this pathology. More often it occurs in able-bodied men after 40 years of age; the hands become deformed and lose their functions.

Modern treatment without surgery

Despite the seriousness of the disease, Dupuytren's contracture can be treated with conservative treatment methods.

For this purpose, various procedures are carried out that can relieve pain and ensure the restoration of normal functions of the limbs.

When prescribing treatment measures, the following are taken into account:

• Reason for appearance;
• Location of scars;
• The degree of tissue damage;
• Patient's age.

Here is a list of treatment procedures to alleviate the condition of patients and accelerate the restoration of joint function:

• Treatment with painkillers, hormones, NSAIDs;
• Therapeutic blockades with the introduction of drugs into the joint cavity in the area of ​​​​the nodes in the palm;
• Manual therapeutic procedures for joints and muscles, UHF, therapeutic exercises and special types massage with elements of self-massage.

Medication therapy includes:

• Glucocorticosteroids in the form of injections into the area of ​​the node, drugs such as diprospan, dexamethasone, Kenalog, which help reduce pain;
• Xiaflexa is a combined drug, administered by injection, which has a destructive effect on collagen;
• Applications with lidase, trypsin, rodinase to the affected areas, they help slow down tissue degeneration, soften the peri-scar tissue, and relieve tension in the hand.

Physiotherapy procedures using mud and paraffin baths, electrophoresis, and phonophoresis for the hands help simultaneously warm up problem areas and provide a mineral “feed” for the sore joint.

All these procedures are effective at the initial stage of contracture development.

What is the disease

Dupuytren's contracture is named after a French doctor who described it in the early 19th century clinical picture diseases. It is otherwise called palmar fibromatosis.

With this disease, the tissue of the tendon of the palmar aponeurosis degenerates, gradually shortens, turning into a scar in the form of a tourniquet.

The palmar aponeurosis occurs in the form of a triangular plate, located under the skin of the palm. Benign compaction of the aponeurosis takes a long time to develop, in some patients it even takes up to 8 years.

At first, patients mistake pathological nodes for calluses. The seal limits the extension of one or more fingers, usually the little and ring fingers.

Subsequently, they curl up and remain in this position. Although the disease is not fatal, able-bodied men engaged in physical labor suffer due to dysfunction of the hand.

Causes of contracture

Scientists do not have the same opinions about the mechanism of the appearance and development of this insidious disease.

The possibility that heredity plays a role is supported by the fact that all family members who suffer from palmar fibromatosis were found to have a gene that was absent in healthy people.

But not everyone who has this gene develops the disease. The onset of the disease probably requires that the body be exposed to some risk factors.


Based on the research of scientists and the observations of doctors based on the anamnesis of patients, we can conclude that the risk factors are:

• Professions involving heavy manual work (loaders, porters, long-haul drivers, mechanics, carpenters, etc.);

• Arm injuries and hand injuries that caused tendon strain;
• Smoking, alcohol abuse;
• Gender and age, most people get sick after 40 years of age;
• The presence of kidney and liver diseases, diabetes, epilepsy, which can cause disorders in connective tissues.

If the disease is detected in the early stages of development, you can get rid of it using conservative treatment methods:

• Medicines;
• Massage;
• Physiotherapy;
• Therapeutic exercise.

Along with these treatment methods, you can use traditional medicine.

How does this pathology manifest itself?

Dupuytren's contracture is a relapsing chronic disease. The connective tissue of the palmar aponeurosis under the skin during contracture degenerates into fibrous tissue, forming dense scars.

Scars gradually cause damage to the joint capsules and tendons. The skin becomes lumpy due to nodules underneath.

There are 3 types of such lesions:

• Palmar;
• Finger;
• Mixed.

During the first stage, lumps in the form of nodules appear under the skin in the palm area, which are initially mistaken for calluses. No one suspects the onset of the disease, because the fingers move and there is no pain. Sometimes you feel pain when you touch it.

The second stage is accompanied by the following signs: the seals become coarser, funnel-like depressions and retracted folds appear on the palm. Extension movements of the hand become limited by about 30 degrees, the patient’s finger does not bend.

Characteristic signs of the third stage of the development of the disease are the following symptoms: the fingers are involved in the process, the movement of which becomes limited by 30-90 degrees.

The sore finger does not straighten and is constantly in a bent position. The patient feels pain in the hand. The function of the affected arm is impaired.

The fourth stage is characterized by more pronounced pathological changes.

Joints and tendons are involved in the process, they contract even more, and strands appear on the palm of the hand.

The affected fingers almost do not straighten and are in a position of more than 90 degrees to the palm. The brush loses its functions and becomes deformed.

In some cases, as the nodule enlarges, connective tissue grows. It begins to compress the blood vessels and nerve bundles, then you have to amputate the finger.

Sometimes they form a fixed joint, as a result of which the fingers cannot bend at all.

Video

Effective ointments

When carrying out complex treatment of contracture, ointments and medicinal gels are used to relieve pain and relieve tissue swelling. Under the influence of ointments, scars and scars become soft and the skin becomes elastic.

Patients note effectiveness after using such ointments.

1. Contractubex, which has the ability to slow down the formation of scar tissue, stimulates collagen production.
2. Kelofibrase - a cream that softens scars, provides good support water balance in the skin. Used against inflammatory processes and to prevent stretch marks after operations.
3. Kelo-cote silicone gel from an American company, which helps in the treatment of various scars after surgery.
4. Fermenkol, which is used both before surgery and after open type contracture surgery, after needle aponeurotomy. Effective together with electrophoresis and phonophoresis in the recovery stage.
5. Dermatix - used after surgical operations after wound healing.

We cope at home with folk methods

Traditional medicine has many means for treating “chicken's feet” (as contracture is popularly called) at home.

They can stop further progression diseases in the initial stages of development.

To treat Dupuytren's contracture at home, use:

• Compresses;
• Rubbing with ointments;
• Baths with decoctions.

Options for preparing a healing ointment

A healing ointment that is prepared by mixing fresh butter with beeswax is effective. It softens scars and rough skin on the palm, relieves irritation, itching and inflammation.

To prepare it, mix 250 g of butter with 100 g of beeswax and 100 g of pine resin. The mixture is boiled for 10 minutes, adding dry celandine 30 g, boiled for another 5 minutes, half a liter is poured into it St. John's wort oil. After bringing to a boil, remove from heat, cool and filter.

Help from home medicinal baths

Use baths with vegetable peelings. To do this, place peelings of beets, potatoes, onions and carrots in a bowl, pour in water and add a spoonful of salt with 20 drops of iodine (calculated for 5 liters of water). The whole mass must be cooked until the vegetables soften.

After the broth has cooled to body temperature, the sore hand is lowered into it and held for 10 minutes, making movements to straighten the fingers. After taking a bath, wrap your hand in a warm soft towel.

Conducting effective massage sessions

Patients respond well to massage using butter. The affected hand is smeared with fresh butter, then make stroking movements for about 5-6 minutes, rubbing your palms and fingers until a mild, tolerable pain appears.

You can use aloe juice. For this purpose, a dense, freshly picked leaf is suitable, which should be thoroughly mashed until juice is obtained. Lubricate the hands of sore hands with the juice that appears and hold for several minutes.

Useful gadgets in the fight against a running process

Healers offer lotions with an infusion of pine or spruce needles with the addition of their cones. Prepare an infusion of 100 g of pine needles in a glass hot water. A cloth soaked in the infusion is applied to problem areas of the hand.

A glass of kerosene is mixed with a glass vegetable oil with the addition of 7-10 pods of hot pepper, passed through a meat grinder. The infusion will be ready in about 10 days. After filtering, it is rubbed into the affected areas with gentle stroking movements.

Tincture of crushed chestnut fruits 300 g in alcohol (0.5 l) also helps well with contracture. Ready in 2 weeks. Before going to bed, lubricate your hands with the resulting tincture.

The need for surgery

There are several methods surgical treatment. When the disease reaches stage 3 of development, at which the contracture of the finger acquires an angle of more than 30°, this indicates that surgical intervention is necessary. Although some doctors suggest surgery at stage II.


In our country, the segmental excision method is used during surgery for Dupuytren's contracture. It is considered a more correct technique when only the affected area of ​​the aponeurosis is removed from the base of the palm to the place where it is attached to the finger.

When deciding on surgery, the patient's age and disease progression are taken into account. When a contracture is removed, the affected tissue is excised so that movement in the joint can be restored later.

The aponeurotomy procedure is performed under general anesthesia or local anesthesia. After excision of the tissue, the surgeon sutures the wound, then a tight sterile bandage is applied to the palm.

The finger is fixed with a functional splint in the position in which a healthy finger is usually found. The bandage is not removed from several weeks to several months, it all depends on the nature of the disease.

In particularly severe cases, another surgical method is used, which is called arthrodesis. During arthrodesis surgery, the finger that is unable to move is fixed in the most advantageous comfortable position. It will not be able to move like a healthy finger, but it will not interfere with the sick one.

Medical equipment with strong optics has appeared in clinics; after microsurgical operations to remove contractures, complications are not observed.

IN Lately They began to use needle aponeurotomy, in which the seals under the skin are pierced with an injection needle in different directions.

The fibers of the cord are damaged, the functions of the finger and hand are restored. This operation requires a lot of experience from the surgeon, because the nerves and tendons of the hand can be affected.

Rehabilitation in the postoperative period

When using needle aponeurotomy, rehabilitation measures can begin within a few hours; this method does not leave wounds or stitches. It is necessary to begin developing the hand with flexion and extension.


When conducting open surgery Rehabilitation should begin after the sutures are removed:

1. After the operation, you need to monitor the joints that are not in plaster so that they are in motion, but in moderation.
2. First day after surgery soft fabrics and the plaster is checked, and on the second or third postoperative day the Redon drainage is removed.
3. On days 5-7 after surgery, the plaster splint is removed and the bandage is changed.
4. Patients should begin daily physical therapy.
5. 2 weeks after the operation, the sutures are removed and the bandage is changed.
6. Once the stitches are removed, the bandage is no longer needed.
7. Begin to carry out regular (3-4 times a day) exercises with hands in cold water(you can even add ice). Cold helps relieve swelling and pain. Those who cannot stand the cold can exercise in warm water.
8. 5 days after removal of the sutures, treatment of the postoperative scar begins.
9. Rub various ointments, for example, calendula ointment, several times a day. The scar softens, it becomes elastic, pain and sensitivity decrease.
10. You can pat the scar with a soft brush.
11. The entire period of patient's disability lasts approximately 4-6 weeks.

Rehabilitation must be continued medical procedures using gymnastics.

Physical therapy for the patient

Performance physical exercise It is considered one of the effective ways to eliminate contracture, muscles contract, joints move, and there is an increased supply of nutrients to the connective tissues of the body.

During physical therapy procedures, extension movements are performed, the muscles of the hand are stretched and act against the tightening of the ligaments of the hand and fingers.

With a healthy hand you can develop bent fingers the affected hand, carefully straightening and bending them until a slight pain appears.

Here are some simple exercises:

1. Snap the brush with each finger several times.
2. Squeeze all 5 fingers into a pinch 10 times. Hands are on the table, palms up.
3. Perform scratching movements on the surface of the table with your fingers, which are palms down.
4. Develops the hands by bending and straightening the fingers lying on the table.
5. Spread your fingers, hands lie palms down, return to the starting position. Repeat 10 times.

Exercises using a power expander give good results. For contracture, strength kinesitherapy is used, which is a synthesis of physical therapy and sports training.

Muscles with contracture are “drawn in” into the pathology process.

And the work of the muscles can be controlled by both the doctor and the patient himself, giving the muscles a feasible load.

Therapeutic exercises can be done in rehabilitation period and for disease prevention. For example, it is easy to perform exercises to bend and straighten your fingers for 5-6 minutes until a burning sensation and compression appear.

With regular exercise, further progression of contracture can be prevented.

Thank you

Skin is the most large organ the human body, which has numerous and very diverse functions. This organ takes part in the processes of respiration, metabolism, thermoregulation, etc. In addition, the skin protects the body from a number of negative factors environment. By the appearance of the outer covering one can judge the general condition of the entire organism as a whole. But what does it “signal” about? dry skin and how dangerous this phenomenon is, you can find out by reading this article.

Dry skin – what is it?

Symptom or normal?

1. In the first case, the skin becomes dry under the influence of certain external factors. This can be either ultraviolet rays, high temperature or low air humidity, frost, wind, etc. Often, excessive dryness of the skin is the result of a variety of therapeutic measures or numerous peeling procedures ( exfoliation of the upper stratum corneum of the skin) or dermabrasion ( skin rejuvenation method). The same changes are possible with external use of retinoids, azelaic acid and some other drugs.

2. Constitutionally dry skin is usually caused by physiological or genetic characteristics. Most often it is observed in children aged 2 to 6 years. It is during this period that a physiological decrease in the synthesis of sebum by the sebaceous glands occurs. Dry skin on the back, legs, face and hands can often be found in representatives of the fairer sex with thin and white skin. skin. Exists in modern medicine and a term like senile xerosis.
Senile xerosis is a clinical symptom characterized by excessive dryness of the skin as it ages. Quite often, the skin becomes dry during premenopause, as well as menopause ( complete cessation of menstruation due to cessation of ovarian function). Constitutionally caused dryness can also be observed with some skin pathologies such as ichthyosis ( hereditary disease characterized by various keratinization disorders).

There is another classification of dry skin, according to which it can be:
1. with good tone;
2. with decreased tone.

1. The surface of dry skin with good tone is smooth, elastic and matte. In addition, there are no wrinkles on it, however, it reacts sensitively to any external irritants, so it requires regular cosmetic care. If you don't take care of it, it will very quickly lose its tone. In most cases, such skin is typical for young people.

2. The surface of the skin with reduced tone is thinned. This is especially noticeable in the area around the mouth and eyes, since it is in these places that early wrinkles and folds appear. Owners of such skin require more modern techniques care for her, since conventional cosmetics are not able to improve her general condition and appearance.

Is it possible to identify dry skin on your own?

• The skin cracks and peels;
• Peels off in scales;
• Itching and discomfort are felt;
• Covered with red spots;
• Very rough and inelastic;
• There are practically no visible pores on it;
• It is especially tight after a bath, shower or swimming;
• You can feel its roughness;
• There are deep cracks that sometimes even bleed.

Why does the skin need water?

The degree of skin hydration is determined by 2 regulatory mechanisms:

• general condition of the stratum corneum;
• total amount of sebum.

Mechanisms that prevent skin dryness

Diseases accompanied by dry skin

1. Hypothyroidism: a specific state of the body that occurs as a reaction to low level hormones thyroid gland. IN in this case The skin becomes especially dry in the elbow area. Other symptoms include drowsiness, hearing loss, split nails, dull hair, swelling of the limbs, etc. All these signs can be eliminated by compensating for the required amount of hormones.

2. Psoriasis or scaly lichen: is a chronic non-contagious skin disease that occurs as a result of disruption of the endocrine and nervous systems or metabolism. In such cases, the skin of patients becomes not only dry, but also inflamed. It swells and begins to peel off. Peeling of the skin in certain areas of the body that have been affected is often observed. The course of treatment for this pathology depends on its form.

3. Atopic dermatitis: a chronic allergic disease that develops in individuals with a genetic predisposition to atopy ( allergies). This disease is not contagious, but it is characterized by a relapsing course, so its treatment will take a lot of time. In such cases, the skin becomes dry and thickened. Crusts are observed in places where scratching occurs.

4. Diabetes: chronic pathological condition, accompanied by a disorder of all types of metabolism due to an absolute or partial lack of insulin in the body, i.e. pancreatic hormone. Skin with diabetes mellitus becomes dry most often in the area of ​​skin folds, although any other areas of the skin can be affected.

5. Eczema: acute or chronic inflammatory disease of the skin, which is allergic in nature and is not contagious. With this pathology, patients complain of dry skin, rash, itching and a burning sensation in the affected area.

6. Stress: general reaction organism to psychological or physical impact, which disrupts his usual state. Such a reaction can provoke the development of a number of symptoms, namely: nausea, abdominal pain, fever, chills, feeling short of air, etc. Frequent stressful conditions are especially dangerous. They lead to uncontrollable anxiety and loss of large amounts of moisture from the body.

7. Kidney failure: pathological condition accompanied by impaired renal function to maintain constancy internal environment body. Patients experience nausea and vomiting, loss of appetite, and decreased consciousness. The skin is typically dry and pale with a yellow tint.

8. Allergic rhinitis : inflammation of the mucous membrane of the nasal cavity, which occurs under the influence of certain allergens and is accompanied by itching in the nose, sneezing and difficulty in nasal breathing. Often this state characterized by dry skin in the area of ​​inflammation.

9. Chronic intoxication: a pathological condition resulting from regular exposure of the body to certain toxic substances that arise in the body itself. In this case, all systems and organs of the human body, including the skin, are affected.

10. Ichthyosis: hereditary dermatosis, characterized by the formation of scales on the skin that resemble fish scales in their entire appearance. Dry skin is especially pronounced on the extensor surfaces of the upper and lower limbs. Sometimes the torso is also affected.

11. Keratosis pilaris: congenital familial pathology that begins to develop in childhood, however, its symptoms become more pronounced only during puberty. The skin of such patients is hard, dry and rough. The extensor surfaces of the upper and lower extremities, the skin of the abdomen and back are affected.

12. Dystrophy: pathological process, in which a particular tissue loses or accumulates substances that are not characteristic of it in its normal state. The skin becomes very dry and pale.

13. Dandruff or seborrhea: pathological condition of the skin caused by dysfunction sebaceous glands, as well as changes in the composition of their secretions. The skin becomes dry only with the dry form of seborrhea.

14. Hypovitaminosis A and PP: represents a lack of these vitamins in the body. A specific symptom is general dryness of the skin with slight pityriasis-like peeling.

15. Sjögren's disease: systemic autoimmune pathology, accompanied by damage to various secreting glands. Dry skin is a common symptom of this pathological condition. In addition, patients experience decreased visual acuity, photophobia, stomatitis, dental caries, etc.

Other Possible Causes

• Bathing in hot water;
• Aging;
• Failure to maintain a healthy lifestyle;
• Frequent washing;
• Taking medications;
• Seasonal factors;
• Climate change;
• Dehydration;
• Inflammatory processes;
• Allergic reactions;
• Irritations;
• Wounds, scratches, cuts;
• Dry air in homes;
• Excessive use of alkaline soaps and cosmetics;
• Disorders of the gastrointestinal tract.

Skin after vacation

What to do?
First of all, it is necessary to humidify the air in the house as much as possible. To do this, place vases with fresh flowers or vessels with water throughout the rooms. While in the car, set the air conditioner or climate control to 85% humidity for at least 7 days. It is very important to carry out several moisturizing procedures under polyethylene. Such procedures will help increase sweating and reabsorption of water by the skin. Just 3 procedures and you don’t have to worry about dry skin.

Fish skin and swimming pool

Skin climax

Weight loss products are also harmful!

Risk factors

IN this group you can enter:

• people over 65 years of age;
• citizens who very often take a hot bath or shower;
• persons living in climates with low humidity or in cold climates.

Possible complications

2. Eczema or atopic dermatitis – a pathology characterized by redness, inflammation, and cracking of the skin;

3. Folliculitis - inflammation hair follicle, characterized by redness and swelling of the affected area. At the site of the lesion, a nodule with an abscess on the surface, which is penetrated by hair, may also form.

The development of all these diseases is possible if improper care behind such skin or against the background of weakening of the protective functions of the skin.

When is it necessary to consult a dermatologist?

• In addition to dryness, there is redness of the skin;
• Your sleep is disrupted due to dryness and itching;
• The efforts made did not help improve the general condition of the skin;
• Ulcers appeared on the skin;
• Large areas of severely flaky skin are observed.

What should the diet be like?

Dry skin in newborns

Dry skin in children

During pregnancy

Best start sticking to some enough simple tips, namely:

• Use emollients;
• Wash your face 2 times a day using foam for dry skin;
• Make a moisturizing mask once a week;
• Drink as much still as possible mineral water, which helps moisturize the skin from the inside;
• If necessary, use a humidifier;
• Use scrubs with small particles only;
• Take a bath no more than once a week, and use healing oils, which contain extracts of medicinal plants.

5 myths about dry skin

Dry skin is a congenital property.
This happens, however, this is not a pattern. The skin can become dry under the influence of cosmetics or due to an unbalanced diet, so it’s not always Mother Nature’s fault.

Myth 2:
Dry skin needs a nourishing cream, but dehydrated skin needs a moisturizing one..
In fact, all skin needs hydration, regardless of its type. Even if you have normal skin, without additional moisturizing, very soon it will become dehydrated, and, consequently, begin to peel and crack.

Myth 3:
Dry skin is dehydrated skin.
This is wrong. These problems are different. In the first case, there is a significant decrease in the production of sebum, but in the second, it is all due to a lack of moisture against the background of impaired barrier functions.

Myth 4:
For dry skin, proper care is enough.
Care alone is not enough. Very often, patients need complex treatment, including a balanced diet, the use of cosmetics, as well as therapy for the underlying disease.

Myth 5:
Dry skin doesn't need water.
Despite the fact that water “washes off” the special protective film, there is no way to do without it, since only with its help can you achieve complete cleansing. Having cleansed the skin, you can be sure that the applied cream will be completely absorbed, and, therefore, will give the necessary therapeutic effect.

Dry scalp - what to do?

This mask is also perfect for caring for dry scalp: thoroughly mix 1 tbsp. l. honey with 2 tbsp. l. olive oil . Pour the resulting mixture into a plastic container. Then take a coffee cup, pour almost boiling water and carefully lower the container into it. After 3 - 4 minutes, take out the container, cut off one of its corners and pour the contents onto your hair. We put on a cap and leave the mask for exactly 15 minutes, after which we wash our hair with shampoo.

It is important to note that the scalp can be dry even in the presence of certain diseases. It could be like psoriasis ( autoimmune pathology characterized by dry, itchy and flaky skin), and baldness or seborrheic dermatitis ( a chronic inflammatory disease that affects those areas of the skin where the sebaceous glands are developed). In all these cases, complex treatment will be required, which can only be prescribed by a specialist.

Dry hand skin and how to deal with it?

• Regularly use soap that contains nourishing cream;
• Dry your hands thoroughly after each wash;
• Wash your hands lightly warm water, then rinse them with cold water;
• Under no circumstances go outside with wet hands, and in cold weather without gloves;
• Rub into skin morning and evening massage movements nourishing cream containing glycerin, which has a moisturizing effect;
• During the hot season, lubricate your hands with sunscreen before going outside;
• Do all housework with rubber gloves;
• Regularly treat your hands with a scrub, which will help get rid of dead cells;
• In the evening after using the cream, put plastic gloves on your hands for 30 minutes.

Masks and compresses for dry skin of hands

Recipe No. 2: mix 2 yolks with 2 tbsp. l. honey and 1/3 cup vegetable oil. Apply the resulting mixture to your hands and hold until it dries, then remove the mask with a damp cotton swab.

Recipe No. 3: one glass of sour cream must be mixed with 1 yolk and the juice of 1 lemon. Spread the resulting mixture in a thick layer on gauze, then wrap your hands in gauze, wrap them in cellophane and wrap them in a towel. After 20 minutes, remove the mask with a damp cotton swab, then put cotton gloves on your hands.

Recipe No. 4: Pour celery root with 1 liter of water and boil it for 60 minutes. Then we filter the resulting broth and use it to wipe our hands.

Recipe No. 5: 1 tbsp. l. steam crushed plantain leaves in 1 liter of boiled water. Strain the resulting infusion and keep your hands in it for at least 20 minutes. After this procedure, your hands must be thoroughly dried and lubricated with a rich cream.

How to properly care for dry skin?

Recipes for some face masks

Mustard mask: mix 1 tsp. mustard with the same amount of vegetable oil and a small amount of boiled water. Apply the mixture to your face for 5 minutes, then wash it off with warm water.

Mask of honey and yolks: Mix 2 yolks with 0.5 tbsp. l. honey and 2 tbsp. l. vegetable oil. Lightly heat the resulting mixture in a water bath and apply it to the face in layers. Each layer should be applied after 5 minutes. Just 3 – 4 layers. After applying the last layer, wait 20 minutes and rinse off the mask with warm water.

Dry skin around the eyes

• Regularly moisturize your skin with special moisturizing creams for the eye area;
• Choose facial cleansers that contain skin-friendly ingredients;
• Apply night cream regularly to the eye area;
• Carefully protect this area from ultraviolet rays;
• Switch to a healthy diet;
• Keep yourself hydrated from within by drinking plenty of fluids daily.

Dry skin on lips

Masks for dry lips

Carrot and cottage cheese mask: mix 1 tsp. carrot juice with the same amount of cottage cheese and apply everything to the lips for 15 minutes.

Mustard or linseed oil mask: Apply one of the oils to your lips for 15 minutes.

All these masks can be applied to the lips no more than 2 times a week.

Dry foot skin in children and adults

Attention! Failure to properly care for this area can cause small cracks to appear, through which both microbes and fungus can easily penetrate.
As for dry skin on the feet of children, it has its own distinctive features. This skin is very susceptible to infections. In addition, it spreads easily inflammatory processes. Insufficient care of the skin of a child’s feet can cause the development of diaper dermatitis ( areas of red, inflamed skin) and diaper rash or prickly heat ( small red rashes). You can avoid all these troubles. To do this, after each hygiene procedure, you need to massage the baby’s feet and lubricate them with baby cream or oil.

Dry skin of the foreskin

Krauroz: inflammation of the foreskin and head of the penis, which has a recurrent form;

Balanitis: inflammation of the skin on the head of the penis, which can develop as a complication of an infectious or non-infectious disease;

Balanoposthitis: inflammation of the glans penis and foreskin.

In the fight against all these diseases, experts recommend paying close attention to genital hygiene, as well as using special drugs, endowed with anti-inflammatory, antiseptic and immunomodulatory effects.

Dupuytren's contracture (or palmar fibromatosis) is a shortening of the tendons and thickening of the skin on the palms caused by a scarring process that leads to loss of finger flexion function. This defect causes excessive development of connective tissue. Often nodules or cords form in the fascia, leading to the formation of fibroids. At the initial stage of Dupuytren's contracture treatment traditional methods quite effective.

Most often, Dupuytren's contracture affects the little finger and ring finger right hand(or both hands). This disease is typical for men over 45 years of age living in Ireland, Scandinavia, and Eastern Europe. If a young person gets sick, the disease is much more severe. Women get sick several times less often than men.

Causes and symptoms of finger contracture

Official medicine has not yet precisely established the causes of finger contracture. However, from observations we can conclude that genetic predisposition is of paramount importance. Doctors also say that people who consume alcohol excessively, smoke, and get sick are more likely to get sick. diabetes mellitus or are engaged in work that involves frequent hand injuries (mechanics, turners, heavy truck drivers, tractor drivers, combine operators).

With Dupuytren's contracture, scarring occurs in the connective tissue of the palm (aponeurosis). Symptoms may not appear for several years. The first degree is characterized by compactions, cords or nodules on the palm and fingers that do not impair the function of the fingers. In the second degree, passive extension of the fingers is limited (they are bent at an angle of 90°). If left untreated, the third stage occurs, when sensitivity in the fingers is lost and the skin on the palms becomes like parchment. With Dupuytren's contracture of the fourth stage, the mobility of the fingers is completely lost (ankylosis develops).

Patients usually go to the doctor only when the functions of the hand are impaired, the arm begins to hurt, or for cosmetic reasons, that is, with Dupuytren's contracture of the third or fourth stage. Most people do not know that this disease can only progress, and in advanced cases, even surgical intervention does not help restore joint function.

Diagnosis and treatment

If you have Dupuytren's contracture, you should consult an orthopedist or surgeon. The first stage of diagnosis is inspection, palpation of the fascia and checking the mobility of the fingers, assessing the extension amplitude. X-rays of the hand may also be prescribed. Laboratory tests are not required.

This disease is treated with both conservative and surgical methods. The choice depends on the stage of the disease. For Dupuytren's contracture of the first or second stage, conservative treatment is prescribed in the form of:

• corticosteroid injections;
• fixing the fingers in an extended position using a splint, splint or plaster cast;
• physiotherapy;
• warm baths;
• massage;
• therapeutic exercises aimed at stretching the fascia.

Surgical treatment methods for Dupuytren's contracture of the hands can be prescribed at any stage. Most often this happens when the flexion angle reaches 30°. The purpose of the operation in any case is to excise the fascia on the palm. This allows you to restore the flexion functions of the hand and fingers. With Dupuytren's contracture of the third stage, a fixed joint is most often formed (arthrodesis is performed). In advanced cases (stage four), the doctor may suggest amputation.

The operation is performed under general or local anesthesia. Preparation through physical therapy and enzyme preparations, aimed at making it easier to separate the skin from scar tissue. If the preparation is done correctly, there is no need to use skin grafting. However, with Dupuytren's contracture, even a successful operation does not guarantee a positive result, especially if it is performed in at a young age. It is important to choose the right recovery complex.

Treatment with traditional methods

At the initial stage of Dupuytren's contracture (“chicken's foot”) and during rehabilitation after surgery, traditional medicine recipes are quite effective: rubbing, compresses, baths, tinctures.

The two most popular rubbings are:

The most popular bath for the treatment of Dupuytren's contracture is made from peelings of potatoes, carrots, beets and onions. The total volume should be approximately 4-5 liters. Water is poured into the container with the purifications, a tablespoon of salt and about 20 drops of iodine tincture in alcohol are added. You need to cook until full readiness. After cooling to 35-36 degrees, you should lower the hand with contracture of the fingers into the mixture for 10-12 minutes and try to stretch the heated tendons. After the procedure, the sore arm is wrapped in a warm cloth.

For the treatment of Dupuytren's contracture traditional healers It is recommended to take chestnut flower tincture internally. A handful of flowers should be poured with half a liter of vodka and left for two weeks. dark place, then strain. Drink 30 drops 3-4 times a day for a month.

Dupuytren's contracture is also treated with massage with butter. The best way to make butter at home is to beat half a liter of country sour cream (pour it into a two-liter jar, add a crust of bread and shake until a lump forms). The massage is done in two steps - fingers and palms should be stroked for 6 minutes, rubbed for 6 minutes.

To alleviate the condition of Dupuytren's contracture, you should change your diet - exclude milk and dairy products, white bread, sugar, pasta from the menu, increase the consumption of seafood and vegetables (cabbage, carrots, radishes, horseradish, spinach, garlic, dill).

Traditional methods for the treatment of Dupuytren's contracture do not contradict the methods official medicine. They can complement and enhance the effect of medications. But it must be borne in mind that the methods listed above are effective only at the initial stage of Dupuytren’s contracture. In order for the fight against Dupuytren's contracture to be most effective, baths, rubbing and massage must be used regularly for quite a long time. It is also necessary to constantly work with the joints of the fingers - try to straighten them, after warming them up.

Prevention measures

Dupuytren's contracture is different from other types similar diseases the fact that it develops continuously and inexorably, and the reasons for its occurrence are not reliably known. Even when the patient changes jobs and begins conservative treatment, there are no guarantees positive result No. Surgical intervention is also not always effective enough, since the tendons in the palms are fragile and combined into a complex mechanism.

If Dupuytren's contracture - family disease, should be addressed increased attention on the condition of the hands, especially if during work it is necessary to keep them bent for a long time. After every hour, it is advisable to take a break for simple gymnastics (flexion and extension of the fingers). When working with metal, your hands must be lubricated with softening cream and always use gloves made of thick fabric.

- This is a non-inflammatory cicatricial degeneration of the palmar tendons. Due to the proliferation of connective tissue, the tendons are shortened, the extension of one or more fingers is limited, and flexion contracture develops with partial loss of hand function. Accompanied by the appearance of a dense knotty cord in the area of ​​the affected tendons. In mild cases, there is a slight limitation in extension; as it progresses, stiffness or even ankylosis (complete immobility) may develop. injured finger or fingers. Treatment is usually surgical.

ICD-10

M72.0 Palmar fascial fibromatosis [Dupuytren's]

General information

Dupuytren's contracture (palmar fibromatosis) is excessive development of connective tissue in the area of ​​the flexor tendons of one or more fingers. The process is localized on the palm. It develops gradually and occurs for unknown reasons. Leads to limited extension and the formation of flexion contracture of one or more fingers. In the early stages of the disease, conservative methods are used, but the most effective way The treatment is surgery.

Dupuytren's contracture is a fairly common disease in orthopedics and traumatology, which is more often observed in middle-aged men. In half of the cases it is bilateral. In approximately 40% of cases the ring finger is affected, in 35% - the little finger, in 16% - middle finger, in 2-3% - the first and second finger. In women, it is detected 6-10 times less often and has a more favorable course. When occurring at a young age, it tends to progress more rapidly.

Causes

Dupuytren's contracture is not associated with disorders of protein, carbohydrate or salt metabolism. Some authors claim that there is a certain connection between the occurrence of the disease and diabetes mellitus, but this theory has not yet been proven.

There are also traumatic (due to injury), constitutional (hereditary features of the structure of the palmar aponeurosis) and neurogenic (defeat peripheral nerves) theories, but the opinions of scientists remain controversial. The constitutional theory is supported by hereditary predisposition. In 25-30% of cases, patients have close blood relatives suffering from the same disease.

Classification

Depending on the severity of symptoms, there are three degrees of Dupuytren's contracture:

• First. A dense nodule with a diameter of 0.5-1 cm is found on the palm. There is a cord located on the palm or reaching the area of ​​the metacarpophalangeal joint. Sometimes pain on palpation is detected.
• Second. The cord becomes rougher and stiffer, spreading to the main phalanx. The skin also becomes rougher and adheres to the palmar aponeurosis. Visible funnel-shaped depressions and retracted folds appear in the affected area. The affected finger (or fingers) are bent at the metacarpophalangeal joint at an angle of 100 degrees, extension is impossible.
• Third. The cord extends to the middle, less often – to the nail phalanx. The metacarpophalangeal joint exhibits flexion contracture of 90 degrees or less. Extension at the interphalangeal joint is limited, and the degree of limitation may vary. In severe cases, the phalanges are located at an acute angle to each other. Subluxation or even ankylosis is possible.

The rate of progression of Dupuytren's contracture is difficult to predict. Sometimes minor restrictions persist for several years or even decades, and sometimes only a few months pass from the first symptoms to the development of stiffness. It is also possible to have a long-term stable course followed by rapid progression.

Symptoms of Dupuytren's contracture

The pathology has a very characteristic clinical picture, which is difficult to confuse with the symptoms of other diseases. A compaction formed by a node and one or more subcutaneous cords is detected on the patient’s palm. Finger extension is limited.

The first sign of the development of Dupuytren's contracture is usually a thickening of the palmar surface hands, usually in the area of ​​the metacarpophalangeal joints of the IV-V fingers. Subsequently, the dense nodule slowly increases in size. Strands appear, extending from it to the main, and then to the middle phalanx of the affected finger. Due to the shortening of the tendon, contracture first forms in the metacarpophalangeal joint, and then in the proximal (located closer to the center of the body) interphalangeal joint.

The skin around the node becomes denser and gradually fuses with the underlying tissues. Because of this, bulges and retractions appear in the affected area. When you try to straighten your finger, the knot and cords become clearer and clearly visible.

Typically, Dupuytren's contracture develops without pain, and only about 10% of patients complain of more or less severe pain. The pain usually radiates to the forearm or even the shoulder. Dupuytren's contracture is characterized by a progressive course. The rate of disease progression can fluctuate and does not depend on any external circumstances.

Diagnostics

The diagnosis of Dupuytren's contracture is made based on the patient's complaints and characteristic clinical picture. During the examination, the doctor palpates the patient's palm, identifying nodes and cords, and also assesses the range of motion in the joint. Additional laboratory and instrumental studies are usually not required to confirm the diagnosis.

Treatment of Dupuytren's contracture

The pathology is treated by traumatologists and orthopedists. Treatment can be either conservative or surgical. The choice of methods is made taking into account the severity of pathological changes. Conservative therapy used in the initial stages of Dupuytren's contracture. The patient is prescribed physical therapy ( thermal procedures) And special exercises to stretch the palmar aponeurosis. Removable splints can also be used to fix the fingers in the extension position. As a rule, they are worn at night and removed during the day.

With persistent pain syndrome Therapeutic blockades with hormonal drugs are used (diprospan, triamcinolone, hydrocortisone, etc.). The drug solution is mixed with a local anesthetic and injected into the area of ​​the painful node. Typically, the effect of one blockade lasts for 6-8 weeks. Please note that the use of hormones is a treatment that should be used with caution. Conservative remedies cannot eliminate all manifestations of the disease. They only slow down the rate of contracture development. The only radical treatment option is surgery.

Clear recommendations regarding the severity of symptoms for which it is necessary to carry out surgical treatment, are currently unavailable. The decision to undergo surgery is based on the rate of progression of the disease and the patient's complaints of pain, limitation of movement and associated difficulties in self-care or performing professional duties.

Doctors usually recommend surgery in the presence of flexion contracture with an angle of 30 degrees or more. The purpose of the operation, as a rule, is to excise scar tissue and restore full range of motion in the joints. However, in severe cases, especially with chronic contractures, the patient may be offered arthrodesis (creation of a fixed joint with fixation of the finger in a functionally advantageous position) or even amputation of the finger.

Reconstructive surgery for Dupuytren's contracture can be performed under general anesthesia or local anesthesia. With pronounced changes in the skin and palmar aponeurosis, surgical intervention can be quite lengthy, so in such cases general anesthesia is recommended.

There are many incision options for Dupuytren's contractures. The most common is a transverse incision in the area of ​​the palmar fold in combination with L- or S-shaped incisions along the palmar surface of the main phalanges of the fingers. The choice of a specific method is made taking into account the location of the scar tissue. During the operation, the palmar aponeurosis is completely or partially excised. In the presence of extensive adhesions, which are usually accompanied by thinning of the skin, free skin flap dermoplasty may be required.

The wound is then sutured and drained with a rubber graduate. A tight pressure bandage is applied to the palm, which prevents the accumulation of blood and the development of new scar changes. The hand is fixed with a plaster splint so that the fingers are in a functionally advantageous position. Stitches are usually removed on the tenth day. Subsequently, the patient is prescribed therapeutic exercises to restore range of motion in the fingers.

Prognosis and prevention

The outcome is usually favorable; after excision of areas of fibrosis, hand movements are restored in full. Sometimes (especially when early occurrence and rapid progression) recurrence of contracture may occur over several years or decades. In this case, repeated surgery is required. Prevention has not been developed.