I have two small nodules in my palm, they are small and painless, but I see (and feel) them below my pinky and ring finger. My doctor’s appointment isn’t for two months and I’m worried. Can you weigh in?”
–C.S., Sacramento, California
Answer: I’m glad you have an upcoming appointment with a doctor who can examine your hand for other signs like dimples, pitted marks or bent fingers. Those little nodules could be related to so many things including Dupuytren’s contracture which stands out in my mind. It starts out with tiny lumps in your palm as you describe. But again, a skilled physician can discern Dupuytren’s from other conditions like trigger finger, stenosing tenosynovitis, a ganglion cyst, soft tissue mass, rheumatoid, sarcoma or something else. I won’t pretend to know what you have, but for the sake of writing this column, I’ll focus on Dupuytren’s contracture because it’s interesting and I’ve not covered it before.
Former president Ronald Reagan, Samuel Beckett and Margaret Thatcher are a few notable sufferers. These “lumps”in the palm suddenly appear, then other symptoms gradually appear. Ultimately, there is a tightening of the tissue in the hand, causing the finger(s) to curl down.
How much time between the appearance of lumps and the actual contracture? It varies, it’s usually months to years. The contracture could be mild, or severe. No one is sure why it happens, but people with diabetes have a higher risk, as do middle-aged men. Other risk factors include your genetics, liver cirrhosis, epilepsy and those who have excessive oxidative stress. Oxidative stress occurs from free radical damage, (like if you smoke, drink, have high insulin, high blood sugar). While researching this, I couldn’t find many people claiming success with surgery. Unfortunately, treating Dupuytren’s contracture doesn’t much attention or funding for studies so I’m happy to share what I know.
With Dupuytren’s, your body produces too much of a cytokine called TGFβ (transforming growth factor beta) and this contributes to fibrogenesis or thickening of the tissue. Reducing TGFβ helps slow the disorder. In 2002, the breast cancer drug Tamoxifen was shown to help Dupuytren’s by reducing TGFβ.
Then in 2009 an article appeared in Medical Hypothesis entitled, “NAC and ACE inhibitors can prevent the recurrence of Dupuytren’s disease.” The researchers slowed fibrogenesis with the dietary supplement called NAC (N-acetylcysteine) or ACE inhibitor drugs (ie lisinopril, enalapril). I think stretching, heat, acupuncture and red light (laser) could help in the early stages.
I also learned of a folk remedy, mix together: 5 ml (equal to 1 teaspoon) of topical Magnesium Oil with 20 to 30 iodine drops and 10 drops DMSO (usually sold online). Store this liquid mixture in an amber bottle. Apply a little bit with a cotton ball to your palm twice daily. Within weeks to months, this may improve contracture. Consult your physician before trying anything.