Current evidence on non-surgical therapies for Dupuytren's disease: A clinical review.

Dupuytren's disease is a chronic fibroproliferative disorder characterized by progressive thickening and contracture of the palmar fascia, leading to nodules, cord formation, and varying degrees of digital flexion deformity. Although the disease most commonly affects the longitudinal fibers of the palmar aponeurosis, it can also involve distal transverse fibers, natatory ligaments, and digital fascial extensions, including Grayson's and Cleland's ligaments. Its clinical presentation is highly heterogeneous, ranging from slowly evolving, stable nodules to rapidly progressive forms associated with aggressive phenotypes such as Garrod's knuckles or spiral cords that may compromise neurovascular structures. Current evidence suggests a multifactorial etiology involving genetic predisposition, aberrant Wnt/β-catenin signaling, biomechanical stimulation, and metabolic factors such as diabetes. While open surgery (limited fasciectomy) has long been considered the gold standard for advanced contractures, its associated morbidity has prompted increasing interest in minimally invasive or adjunctive non-surgical treatments. Collagenase Clostridium histolyticum (CCH) injections have demonstrated rapid functional recovery and acceptable safety, although recurrence rates remain higher than those of open surgery. Percutaneous needle aponeurotomy offers a simple, low-cost outpatient alternative with excellent short-term correction but significant long-term recurrence, particularly in PIP joints. Radiotherapy has been proposed for early nodular disease and may stabilize progression in selected patients, yet current evidence is methodologically weak and insufficient to support routine use. Pharmacologic approaches-including antifibrotic agents, tyrosine kinase inhibitors, intralesional corticosteroids, and emerging biologics such as anti-TNF therapies-remain experimental, with limited clinical validation to date. Rehabilitation, including supervised exercises and nighttime orthoses, is frequently used following minimally invasive interventions, although high-quality evidence supporting their long-term efficacy is lacking. Overall, non-surgical therapies expand the spectrum of management options for patients with Dupuytren's disease, particularly those presenting with early-stage nodular disease or mild-to-moderate contractures who seek less invasive alternatives to open surgery. However, these treatments vary considerably in durability, recurrence rates, and level of supporting evidence. Consequently, therapeutic decisions must be individualized, taking into account disease stage, anatomical involvement, patient expectations, risk tolerance, and clinician expertise. Continued research is needed to refine patient selection criteria, optimize treatment combinations, and evaluate emerging molecular therapies targeting the disease's underlying pathobiology.