December 28, 2023 usdore

A bird flu primer: What to know and do

A weathered sign with red background and big white and black letters spelling out bird flu

A bird flu strain that began circulating in 2020 continues to evolve globally and locally within the United States. If you’re wondering what this means, understanding the basics — what bird flu is, how it spreads, whether foods are safe, and prevention tips — can help. More information will come in as scientists learn more, so stay tuned.

1. What is bird flu and how does it spread?

Bird flu, or avian flu, is a naturally occurring illness. Just as certain flu viruses spread among humans, Type A influenza viruses often spread among wild birds. The strain of virus circulating now is H5N1, named for two proteins on its surface.

Avian flu infections are highly contagious. Infection often spreads first among wild water birds, such as ducks, geese, and gulls, and shore birds, such as plovers and sandpipers. The viruses are carried in their intestines and respiratory tract and shed in saliva, mucus, and feces. Wild birds can easily infect domestic poultry, such as chickens, turkeys, and ducks.

Some bird species, including ducks, may carry and spread infection without appearing sick. Domestic flocks are more likely to sicken and possibly die from bird flus. However, not all avian flu viruses are equally harmful:

  • Low pathogenic avian influenza (LPAI) may cause no signs of illness, or signs of mild illness like fewer eggs or ruffled feathers in domestic poultry.
  • Highly pathogenic avian influenza (HPAI) causes more severe illness and high rates of death in infected poultry. The current H5N1 virus is considered an HPAI.

2. Can humans get bird flu?

Yes, though this doesn’t usually happen.

When flu viruses mutate, they may be able to move from their original hosts — birds in this case — to humans and other animals. As of early April 2024, only two cases of bird flu in humans had been reported in the US since 2022. In May, two more cases were reported. Newer case numbers of bird flu will continue to be reported by the CDC, which offers weekly snapshots of influenza in the US.

The virus may be introduced into the body through the eyes, nose, or mouth. For example, a person may inhale viral particles in the air (droplets, tiny aerosolized particles, or possibly in dust). Or they might touch a surface contaminated by the virus, then touch their eyes or nose. Bird flu in humans typically causes symptoms similar to seasonal flu, such as fever, runny nose, and body aches.

3. Which animals have been affected by bird flu?

A surprisingly long list of animals affected by the current H5NI bird flu infection includes:

  • wild birds, chickens, ducks, geese, and other domestic and commercial poultry in 48 states and more than 500 countries
  • livestock, such as dairy cows in nine states at this writing, and other farm animals
  • marine animals, such as seals, sea lions, and even dolphins
  • wild animals, such as foxes, skunks, and racoons, and some domestic animals, such as farm cats.

4. Why are experts concerned about this bird flu outbreak?

It might seem odd that there’s been so much concern and news coverage about bird flu lately. After all, bird flu has been around for many years. We’ve long known it sometimes infects nonbird animal species, including humans.

But the current outbreak is unique and worrisome for several reasons:

  • Fast, far-reaching spread. The virus has been found throughout the US, Europe, the Middle East, Southeast Asia, multiple sub-Saharan African countries, and even Antarctica.
  • Many species have been infected. Previously uninfected species have been affected, including animals in our food supply.
  • Economic impact. If large numbers of beef and dairy cows and chickens sicken or must be culled (killed) to contain outbreaks, this could have a major economic impact on farmers, agriculture businesses, and affected countries’ economies. This could also mean higher prices at the grocery store.
  • Opportunities for exposure. Though only two human infections were reported in the US in recent years — both in people working with animals — the more exposure humans have to bird flu, the more chances the virus has to develop mutations that allow easier spread to humans.
  • Potential for fatalities. Severe strains of bird flu have led to H5N1 infections in nearly 900 people in 23 countries since 2003. More than half of these reported cases were fatal. Keep in mind that the math isn’t straightforward. It’s likely that many more cases of bird flu in humans occurred, yet people experiencing few or no symptoms or those not tested weren’t counted, so lethality is likely overestimated.
  • New mutations. It’s rare, but possible: If this H5N1 bird flu develops mutations that enable efficient person-to-person spread, bird flu could become the next human pandemic.

5. Are milk, beef, chicken, and the rest of our food supply safe?

Public health officials emphasize that the food supply is safe.

But concern has understandably run high since the discovery that this outbreak has spread from birds to dairy cows for the first time. More alarming? A study found fragments of bird flu DNA — which is not the same as live virus — in 20% of commercially available milk in the US.

So far, there’s been no indication that bird flu found in pasteurized milk, beef, or other common foods can cause human illness. Even if live bird flu virus got into the milk supply, studies show that routine pasteurization would kill it. Initial tests did not find the virus in ground beef.

Of course, if you are particularly concerned, you could avoid foods and beverages that come from animals affected by bird flu. For example, you could switch to oat milk or almond milk, even though there’s no convincing scientific justification to do so now.

6. What if you have pets or work with animals?

Bird flu rarely spreads to pets. While that’s good news, your pets could have exposure to animals infected with bird flu, such as through eating or playing with a dead bird. So, it’s safest to limit your pet’s opportunities to interact with potentially infected animals.

If you work with animals, especially birds or livestock, or hunt, the Centers for Disease Control and Prevention (CDC) recommends precautions to minimize your exposure to bird flu.

7. What else can you do to stay safe?

The CDC recommends everyone take steps to avoid exposure to bird flu, including:

  • Avoid contact with sick or dead animals and keep pets away from them.
  • Avoid animal feces that may be contaminated by birds or bird droppings, as might be common on a farm.
  • Do not prepare or eat raw or undercooked food.
  • Do not drink raw (unpasteurized) milk or eat raw milk cheese or raw or undercooked foods from animals suspected of having bird flu infection.
  • Wear personal protective equipment (PPE), such as safety goggles, gloves, and an N95 face mask, when working near sick or dead animals or their feces.

Right now, available evidence doesn’t support more dramatic preventive measures, such as switching to an all-plant diet.

8. Is there any good news about bird flu?

Despite all the worrisome news about bird flu, this recent outbreak may wind up posing little threat to human health. Virus strains may mutate to spread less efficiently or to be less deadly. Efforts are underway to contain the spread of bird flu to humans, including removing sick or exposed animals from the food supply and increased testing of dairy cattle before transport across state lines.

And there is other encouraging news:

  • Some birds appear to be developing immunity to the virus. This could reduce the chances of continued spread between birds and other animals.
  • Developing a vaccine to protect cattle from bird flu may be possible (though it’s unclear if this approach will be successful).
  • If spread to humans does occur, genetic tests suggest available antiviral medicines could help treat people.
  • So far, human-to-human transmission has not been detected. That makes it less likely that the H5N1 bird flu will become the next pandemic.
  • And if human infections with bird flu did become more common, researchers are working on human vaccines against bird flu using virus strains that match well with those causing the current outbreak.

9. How worried should you be about bird flu?

Though there’s much we don’t know, this much seems certain: bird flu will continue to change and pose challenges for farmers and health experts to stay ahead of it. So far, public health experts believe that bird flu poses little health risk to the general public.

So, it’s not time to panic about bird flu. But it is a good idea to take common sense steps to avoid exposure and stay current on related news.

For updated information in the US, check the CDC website .

About the Authors

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD photo of Francesca Coltrera

Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and a senior content writer and editor for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

photo of John Ross, MD, FIDSA

John Ross, MD, FIDSA, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. John Ross is an assistant professor of medicine at Harvard Medical School. He is board certified in internal medicine and infectious diseases, and practices hospital medicine at Brigham and Women’s Hospital. He is the author … See Full Bio View all posts by John Ross, MD, FIDSA

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December 27, 2023 usdore

Is there a good side to drug side effects?

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Drug side effects are common, and often quite troublesome.

Major side effects, such as severe or even life-threatening allergic reactions, require immediate treatment and discontinuation of the drug. More minor symptoms may be tolerable when weighed against drug benefits. And sometimes, these go away on their own as the body gets used to the drug.

But there’s another type of side effect you hear much less about: ones that are beneficial. Though uncommon, they’re worth keeping in mind when you’re starting a new medicine.

Aren’t all side effects bad?

The term side effect is usually assumed to be a bad thing. And that’s typically true. But that leaves out the “good” side effects. Relatively little is published on this, so it’s not clear how common they are. But four notable examples include:

  • Minoxidil (Rogaine, Gainextra, other brands). Developed in the 1970s for high blood pressure, this drug also increased hair growth in study subjects. What was initially considered a bothersome side effect eventually became its primary use: topical forms of this drug are commonly used to treat hair loss.
  • Diphenhydramine (Benadryl or generic versions). This common treatment for allergic conditions has the side effect of drowsiness. For adults with allergy issues and trouble sleeping, the sedative effect can be helpful. Regular, long-term use of diphenhydramine is not recommended, as it may increase the risk of dementia.
  • Sildenafil (Viagra or generic versions). Originally developed as a treatment for high blood pressure and angina, it didn’t take long for male users to realize the drug could trigger erections within 30 to 60 minutes. The makers of sildenafil recognized that under the right circumstances, this could be a highly beneficial side effect. In 1998 it was approved as a treatment for erectile dysfunction.
  • Semaglutide (Ozempic, Wegovy, Rybelsus). This drug was developed to treat diabetes, but early users noticed reduced appetite and significant weight loss. Now, several formulations of these related drugs are approved for diabetes and/or weight loss.

In the best study I’ve read on the topic, researchers found more than 450 reports of serendipitous beneficial effects of various drugs since 1991. And that may be an underestimation, since report forms did not specifically ask for or label this type of side effect, according to the study authors.

Silver linings: Repurposing and repackaging drugs

While the discovery of helpful drugs can arise unexpectedly, drug developers are increasingly using a more intentional approach: using side effect profiles to look for new uses.

For example:

  • A drug reported to cause reduced sweating as a side effect may be effective for hyperhidrosis, a condition marked by excessive sweating.
  • Drugs reported to cause low blood pressure as a side effect might be effective treatments for high blood pressure (hypertension).
  • New treatments for breast cancer may include older medicines that have a similar side effect profile as known anti-cancer drugs.

The availability of large side effect registries has made this method of identifying drugs for repurposing a more realistic option. So, even negative side effects can have a silver lining.

Bad side effects and the nocebo effect

While side effects can be positive, most are not. Medication side effects are a common reason people give for not taking prescribed drugs regularly. And adverse reactions to medicines prompt up to 8% of hospital admissions, according to one analysis.

To make matters worse, in some cases the expectation of side effects seems to make them more likely to occur. Called the nocebo effect, it increases the chances of experiencing a negative side effect and seems due, at least in part, to expectations. Contrast this with the placebo effect, where a sugar pill or another inactive treatment can lead to benefit.

The bottom line

Many people avoid taking medications because they fear possible side effects. That’s understandable. But not taking a medication can mean missing out on its benefits. And anticipation or expectation of side effects can increase the chances you’ll have them.

So, while it’s important to be aware of the most common side effects caused by the medicines you take, it’s also important not to overestimate your chances of experiencing them. And remember: there’s always a chance you’ll have a side effect you actually welcome.

About the Author

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

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December 17, 2023 usdore

Sexually transmitted infections: What parents need to be sure their teens know

A conceptual drawing of a kiss showing two young people from below the knees, one on tiptoes in untied red sneakers and cropped pants, one in black sneakers

It’s never easy for parents to talk to their teens about having sex. Many parents feel that talking about it is the same as condoning it, so they are hesitant to do so. But according to the most recent Youth Risk Behavior Survey (YRBS), a national survey of high school students, by the end of high school 30% have had sex.

It can be impossible to know for sure if your teen has had sex. Even if they haven’t, it’s likely that at some point they will — and they need to have information to help keep themselves safe and healthy.

What parents should know about sexually transmitted infections

Sexually transmitted infections, or STIs, are very common. They may be caused by bacteria, viruses, or other microorganisms, and spread through all kinds of sex. While most STIs are treatable, they can affect fertility in both women and men, can cause health problems for a baby during pregnancy, and can sometimes lead to lifelong infection or serious complications. That’s why teens need to know about them.

Below are the high-level facts about some of the most common infections: what causes them, what symptoms may occur, and how they are treated.

Chlamydia

Chlamydia is the most frequently reported bacterial STI in the United States — but just as many cases are asymptomatic, so the numbers may be higher than we realize.

Symptoms, if they are present, can include discharge from the vagina or penis, pain with urination, or pain and swelling of the testicles (this is rare). A test of the urine (or a swab from the affected area) can diagnose it, and it is curable with antibiotics. If left untreated it can lead to infertility, more commonly in women than men.

Gonorrhea

Gonorrhea is another STI caused by a bacteria, and it can also be asymptomatic. When symptoms occur, they are very similar to chlamydia. Gonorrhea also can cause infertility in both women and men. While it is treatable, some infections have been resistant to the usual antibiotics used, so additional testing and treatment is sometimes needed.

Trichomoniasis

Trichomoniasis is caused by a protozoa. It is another STI that can be asymptomatic. When there are symptoms, they are usually itch, irritation, and discharge. It is curable with medication.

Syphilis

Syphilis has been on the rise. In the first stage of infection there is usually a firm, round, painless sore where the infection entered the body. The sore is generally there for three to six weeks, but as it is painless it may go unnoticed.

In the second stage there is a more extensive rash, though it can be faint and go unnoticed, along with general feelings of illness such as fever, sore throat, fatigue, swollen lymph nodes, or weight loss.

If syphilis still goes unnoticed it can linger in the body for years, sometimes affecting organ systems, including the brain. It is curable with antibiotics, but if found late the damage it can do may be permanent. This infection can be very serious during pregnancy.

HSV

HSV (herpes simplex virus) causes blistering sores. There is both oral herpes (mouth sores) and genital herpes. Oral herpes, caused by HSV1, is not usually caused by sex — but it can lead to genital herpes through oral sex. Genital herpes is more commonly caused by HSV2.

The sores of herpes can recur throughout life. There is no cure for herpes, but there are medications that can shorten or prevent outbreaks. This infection can be particularly dangerous during pregnancy, although the risks can be managed with good prenatal care.

HPV

HPV (human papilloma virus) is the most common sexually transmitted infection. It can be transmitted even by close skin-to-skin touch, and infections are generally asymptomatic.

Most cases of HPV (90%) get better by themselves — but if they don’t, over time the virus can cause genital warts or certain cancers. Luckily, there is an effective vaccine to prevent HPV that can be given starting at age 9.

HIV

HIV (human immunodeficiency virus) is more common among people who have other STIs — mostly because having STIs is a sign of risky sexual behavior. It can be very hard to know if a person has it, because the early symptoms can feel like having the flu, and then people can move into a long period of time of having no symptoms at all.

While there is no cure for HIV, there are medications to control it, as well as medications that can prevent it.

Talking to teens about preventing STIs

All of this sounds scary. But there are actually some simple things teens can do to prevent infections or minimize complications, which is why parents need to talk with them.

Teens can:

  • Use condoms every single time they have sex — and use them properly. According to the report mentioned above, about half of sexually active high schoolers don’t use condoms regularly.
  • Limit their number of sexual partners — and have frank conversations with those partners before having sex. Asking about sexual history, and getting testing before starting a sexual relationship, can make a difference.
  • Get tested regularly. Sexually active teens should be tested for gonorrhea and chlamydia every year, or more frequently based on their sexual history or symptoms. Testing for other infections may be a good idea too. In the YRBS, 95% of high schoolers had not been tested for STIs in the past year, which is frightening given that nearly a third report being sexually active.

Make sure your teen sees their doctor regularly. And encourage them to be honest with their doctor during their visits. As a parent, you can help by giving your teen confidential time alone with the doctor.

About the Author

photo of Claire McCarthy, MD

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

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December 8, 2023 usdore

Have you exfoliated lately?

Exfoliation products arranged diagonally on a cream-colored background: brushes, pumice stones, rough-knit mitt, serums, lotions & more

Social media has a way of making the ho-hum seem fresh and novel. Case in point: exfoliation, the process of removing dead cells from the skin’s outer layer. Anyone scrolling through TikTok lately might be convinced this longtime skin care approach can transform something old — let’s say our aging epidermis — into like-new skin.

But a Harvard dermatologist says that’s asking too much.

“I don’t think exfoliation is going to fix anybody’s wrinkles,” says Rachel Reynolds, MD, interim chair of dermatology at Harvard-affiliated Beth Israel Deaconess Medical Center. While exfoliation offers definite benefits, it can also irritate and inflame the skin if you don’t do it carefully, or use tools or chemicals your skin doesn’t tolerate.

How is exfoliation done?

There are two main ways to exfoliate: mechanical and chemical. Each boasts specific advantages.

  • Mechanical (or physical) exfoliation uses a tool such as a brush or loofah sponge, or a scrub containing abrasive particles, to physically remove dead skin cells. “Mechanical exfoliation can improve skin luster by taking off a dead layer of skin that can make it look dull,” Dr. Reynolds says. “And it can help unclog pores a bit, which can reduce some types of acne.”
  • Chemical exfoliation uses chemicals — often alpha and beta hydroxy acids or salicylic acid — to liquify dead skin cells. “Chemical exfoliants work on a more micro-level to help dissolve excess skin cells and reduce uneven pigmentation sitting at the surface of the skin,” she explains. “They also restore skin glow, improve acne, and give the skin a little more shine.”

Why do skin care products so often promote exfoliation?

Perhaps hundreds of commercially available skin care products — from body washes to cleansers to face masks — are labeled as exfoliating, Dr. Reynolds notes. But she’s skeptical about why such a wide array of items plug this feature so prominently.

“It’s advantageous for a cosmetics company to sell consumers more products in a skin care line,” she says. “But it’s buyer beware, because this is a completely unregulated market, and cosmetic companies can make claims that don’t have to be substantiated in actual clinical trials.”

Do we need to exfoliate our skin?

No. “Nothing happens if you don’t exfoliate — you just walk around with bumpy or slightly dry skin, which is inconsequential except for cosmetic reasons,” Dr. Reynolds says.

“No one has to exfoliate, but it can be helpful to exfoliate the arms and legs,” she adds. “As we age, these areas get more dry than other parts of the body, and people notice they build up a lot more flaking skin and an almost fish-scale appearance.”

That phenomenon may or may not be a sign of keratosis pilaris, a common but harmless skin condition characterized by rough, bumpy “chicken skin” on the upper arms and thighs. Physical exfoliators are a good first choice because keratosis pilaris covers areas that have tougher skin than the face, she says. But it’s fine to use a cleanser or lotion containing a chemical exfoliant instead. Either type can improve skin texture and the skin’s appearance.

Can exfoliation harm our skin?

Yes. Both physical and chemical exfoliation techniques can do more harm than good, depending on several factors. Sensitive skin is more likely to become irritated or inflamed by any exfoliant. And overdoing it — whether by rubbing too hard or using a product with higher concentrations of acid — can trigger irritant contact dermatitis, which can look red, angry, and chapped.

“Physical exfoliation that’s done too harshly can also aggravate inflammatory acne, making it worse,” Dr. Reynolds says. “Also, exfoliating can make you more prone to sunburn.”

What are the safest ways to exfoliate?

Dr. Reynolds recommends chemical exfoliants over physical versions. “Sometimes the abrasives in those apricot scrubs, for example, can go too far, aggravating the skin and creating inflammation,” she says.

She offers these additional tips to exfoliate safely:

  • If you haven’t exfoliated before, start with a simple washcloth to determine how well your skin responds to mild attempts at physical exfoliation.
  • Then try gentler chemical exfoliants, such as lower concentrations of hydroxy acids or salicylic acid. Work your way up to stronger concentrations only if needed.
  • If you’re hoping to eradicate stubborn skin problems such as melasma (brown facial patches) or comedonal acne (small, skin-colored bumps often on the forehead or chin), consider undergoing a chemical peel at a dermatologist’s office.

Don’t exfoliate every day. “At most, do it two or three times a week,” Dr. Reynolds says. “Your skin needs to repair itself in between exfoliation episodes.”

About the Author

photo of Maureen Salamon

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

photo of Howard E. LeWine, MD

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

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December 6, 2023 usdore

Dupuytren’s contracture of the hand

White and gray 3-D xray illustration showing the bones of the hand against a black background

One of the more unusual conditions affecting the hands and fingers is Dupuytren’s contracture (also called Dupuytren’s disease). Here, one or more fingers become curled, which can make it difficult to pick up or hold objects or perform everyday activities.

Legend says the condition originated with the Vikings of Northern Europe, although this is debated. It was later named after the 19th-century French surgeon Guillaume Dupuytren, who did the first successful operation on the condition. Fast-forward to the 21st century, and Dupuytren’s contracture now affects about one in 20 Americans.

What is Dupuytren’s contracture?

Fascia is a sheet of fibrous tissue beneath the skin of the fingers and the palm. Dupuytren’s contracture is a thickening and shortening of this tissue.

This thickened area begins as a hard lump called a nodule. Over years to decades, it may progress to a thick band called a cord that causes one or more fingers to curl toward the palm and become stuck in a bent position. This can make it difficult to grasp objects, button clothes, use a computer, or perform other daily tasks.

The condition does not always get progressively worse. It may be stable for years or even improve in some people.

Which fingers are most likely to be affected?

The ring and pinky fingers are most often affected. But the condition can strike all fingers and the thumb.

“In about half of cases, the condition can affect both hands,” says Dr. Phillip Blazar, an orthopedic surgeon and Division Chief of Hand and Upper Extremity at Harvard-affiliated Brigham and Women’s Hospital. Fortunately, it rarely causes pain.

What causes Dupuytren’s contracture?

Currently, the cause is unclear. Still, several factors can increase a person’s risk, such as

  • Genetics: This condition is more common in people with Northern European, British Isles, or Scandinavian ancestry.
  • Gender: Men are affected more often than women.
  • Age: The condition often occurs after age 50.
  • Family history of the disease.

People with diabetes and seizure disorders are also more likely to have Dupuytren’s. The condition may appear and/or worsen after trauma to the hand.

How is Dupuytren’s contracture treated?

Although there is no cure, treatments and occupational or physical therapy can help address symptoms and improve finger mobility. “Many people who have mild cases of Dupuytren’s find it has little impact on their ability to use their hands,” says Dr. Blazar.

However, moderate or severe cases can interfere with hand function. It’s possible to restore normal finger motion with nonsurgical treatments, such as:

  • Collagenase injection. This procedure is done in the doctor’s office. An enzyme called collagenase is injected into the cords of your hand, which breaks down and dissolves the thickened tissue. At a follow-up visit, your doctor will give you local anesthesia and then snap the cords by manipulating and straightening your fingers in the direction in which they are unable to move.
  • Needle aponeurotomy. This in-office procedure involves passing a hypodermic needle back and forth through the restrictive cords to weaken and break them.

“Your hand surgeon will discuss both treatment options to determine which is best for your situation,” says Dr. Blazar. “There are also some variations in the anatomy of the disease which may make one treatment or the other less favorable for a particular person or finger.” Both of these treatments don’t remove the cords, and the condition can return and require additional treatment.

What about surgical treatment?

If nonsurgical treatment does not relieve symptoms or you have a severe condition, surgery may be recommended. Surgical approaches include:

  • Fasciotomy. An incision is made in your palm to divide the thickened tissue in the cord.
  • Subtotal palmar fasciectomy. A zigzag incision is made along the creases in the hand to remove the abnormal tissue and cord. Occasionally, a skin graft may be needed to help the wound heal.

You wear a splint on the repaired hand during recovery. People should expect some pain, stiffness, and swelling afterward. The length of recovery varies for each individual, and also with how many fingers were operated on and which ones.

“Most people largely recover by three months, but some may not feel fully recovered for quite a bit longer,” says Dr. Blazar. Hand therapists can also help with strength and flexibility exercises to speed recovery.

Most people’s fingers move better after surgery. However, as with nonsurgical treatments, the contracture can come back, so some people may need additional surgery later on.

About the Author

photo of Matthew Solan

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

photo of Howard E. LeWine, MD

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

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