Harvard Men's Health Watch

Unfolding bent fingers: New handiwork for bacteria

In the age of swine flu, anthrax, SARS, HIV, and drug-resistant tuberculosis, microbes are high on nearly everyone's list of villains. But scientists have learned to harness some of the most dangerous critters, using microbial components or products to fight disease. Immunizations are the obvious example, but other applications are increasing. For example, while the bacterium Clostridium botulinum can cause lethal outbreaks of botulism, it also produces Botox. And now doctors can inject an enzyme produced by Clostridium histolyticum, a bacterial cause of deadly gas gangrene, to treat a common, sometimes disabling hand condition called Dupuytren's contracture.

What is Dupuytren's?

You may never have heard of the condition or the French surgeon responsible for its difficult name, but you've probably met someone with the problem. Affecting 2% to 42% of various population groups, Dupuytren's is one of the most common chronic hand conditions. It is particularly prevalent in older white men of Northern European descent; President Ronald Reagan was one of the many famous people who've had Dupuytren's.

The process affects tissues in the palm of the hand. The first stage is thickening and pitting of the skin. Next comes a painless nodule, which is followed by firm cords that develop along the tendons responsible for bending the fingers toward the palms. Over time, the cords tighten, bending the fingers inward. Although any finger can be affected, the ring and pinky fingers are most often involved, frequently in both hands (see figure).

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