Deformity, aggressiveness and severity of Dupuytren's

When is the most effective time to treat Dupuytren's and what is the best treatment? These are not easy questions. Dupuytren's responds differently and recurs differently in different people: starting with the same deformity (how bent the fingers are), people who do worse are described as having "aggressive" Dupuytren's. Severity is a combination of the measure of deformity and an estimate of aggressiveness. Genes determine whether or not someone will develop Dupuytren's and to a degree how aggressive it will be. External factors, such as alcoholism, amplify aggressiveness. Optimum treatment would be individualized based on severity, but a standard evaluation of all available factors is needed. This report analyzes a new system for estimating severity of Dupuytren's: http://www.dupuytrenfoundation.org/DupPDFs/2008_Hindocha_1014.pdf