Dupuytren's contracture and phenobarbital: our case reports and review of the literature.

Abstract

Background: Dupuytren’s contracture is a fibroproliferative condition involving the superficial palmar fascia, leading to a progressive and irreversible flexion of the fingers. In literature, there are different opinions regarding the phenobarbital, a common antiepileptic drug, and its effective role in the genesis and development of Dupuytren’s disease. In our this retrospective study the association between phenobarbital and Dupuytren’s contracture is discussed. Case Reports: Three patients in treatment with phenobarbital who had no others significant risk factors for Dupuytren’s contracture were included in this study. The disease occurred after one to four years of drug therapy, at dosage of 100 mg/day. After surgery, Dupuytren’s disease showed different evolutions in relation to dosage and type of antiepileptic drug used. Conclusions: We believe that phenobarbital causes a dose and time-dipendent profibrotic effect. We notice a clinical regression when phenobarbital was substituted by carbamazepine, maintaining the same dose (100 mg/day). This data confirms that not all the antiepileptic drugs are implicated in palmar fibrosis, and suggests that, according to the efficacy and adverse effects, the administration of benzodiazepine reduces the risk of Dupuytren’s recurrence.