Dupuytren’s disease has been reported on black patients: Mennen [6] reported only 5 cases of Dupuytren’s disease in black South Africans, free of any Caucasian genetic load. Coulibaly et al. [7] reported a population of black Senegalese people included 20 men and 6 women averaging 63.5 years of age (range 45 - 77). In the United States of America, Saboeiro et al. [8] showed that the prevalence of the Dupuytren’s disease in black patients was 130 per 100,000 inhabitants versus 734 for whites. These various African studies [6] [7] only concerned black African adult people.

The notion of an initial trauma in the palm of the hand was reported in our young patient. A single trauma can trigger the Dupuytren’s disease, as was the case in our patient. These authors [9] therefore underline the influence of microtraumas. There is a relationship between the initial trauma and the development of the Dupuytren’s disease in our patient, an African child with black skin, thus meeting the six criteria of Elliot and Ragoowansi [9] below: 1) existence of a true trauma to the palm of the left hand without pre-existing Dupuytren’s disease lesion; 2) trauma to the left hand on the same side where the disease developed; 3) the patient was not within the age criteria predisposing him to the Dupuytren’s disease or diathesis, our patient being 10 years old at the time of the trauma; 4) the disease appeared within a year of the trauma and he was operated on a year later, at age eleven; 5) appearance of a single nodule in the palm of the traumatized left hand; 6) the disease remains isolated to the part affected by the trauma, that is to say the palm of the left hand.

In our patient, the analysis of the slides presents irrefutable proof of the Dupuytren’s disease. We observed a multinodular lesion, poorly delimited with alternating hyper- and hypo-cellular areas, hyalinized (4X) and uniform fibroblasts, with normochromatic, small, elongated, sometimes vesicular nuclei, with a small central nucleolus (20X). Histological confirmation of the Dupuytren’s disease is therefore essential given the differential diagnosis of the disease.

Differential diagnosis for Dupuytren’s disease in children [10] [11] include nodular fasciitis, extra-abdominal fibromatosis, calcifying aponeurotic fibroma, infantile fibrosarcoma, fibroma of the tendon sheath, localised nodular tenosynovitis (giant cell tumour of the tendon sheath), fibrous hamartoma of infancyand infantile myofibromatosis. Calcifying fibroma affects mainly children and adolescents and presents as a relatively small mass most often located in the palm. Histologically, more significant difference is the invariable presence of calcified foci surrounded by plumper cells.

Goetzee & Williams reported the first histologically proven case of the Dupuytren’s disease in a 14-year-old boy with flexion contractures of the ring finger and little finger with similar plantar fascia disease [12]. Bebbington and Savage reported three histologically proven cases in children under 9 years of age, only two of which were infants [13]. Cheryl et al. [14] studied 108 cases of fibromatosis in children over a 25-year period, among which there were only three cases of Dupuytren’s disease. The Dupuytren’s disease is therefore rare in infants and children.

We cannot provide to give solid evidence that the lump removed from the child’s hand could effectively be a Dupuytren disease: the anatomical location of the nodule is very proximal and ulnar. The site seems to be more linked to the fascia of the hypothenar muscles in the absence of a retraction, one cannot conclude that the lump is a clinical Dupuytren. Although compatible with Dupuytren, the histology is nonspecific and there is unfortunately no specific marker for this pathology. We can thus not conclude only based on histology―a couple of differential diagnosis of post traumatic lump on young population are evoked, but we can’t forget the nodular fasciitis which is rare but the most probable diagnosis in the absence of retraction and in the context of a trauma with a similar histology.

Indeed, factors such as the age of the patient, the rapid appearance of a painful subcutaneous posttraumatic nodule at the level of the hypothenar eminence, as well as the macroscopic aspect of the nodule in continuity with the muscular fascia, visible on the peroperative photograph (Figure 1), are all these elements which can plead also in favor of nodular fasciitis.

We do not find in the literature the studies with reporting the clinical and histological observation of nodular fasciitis in the palmar surface of hand in a black African child. This would therefore be the first report.

In our patient, the treatment was essentially surgical, consisting of excision of the nodular fibrous tumor with its immediate aponeurotic environment. Surgery remains the standard treatment for the Dupuytren’s disease. Currently, there is no proven preventive treatment or effective medical treatment to cure the Dupuytren’s disease in children. We can nevertheless recommend injections of corticosteroids in the painful nodule as in adults. Furthermore, no adequate study has been performed on the relationship between age and the effects of injection of steroids, collagenase and enzymes in the pediatric population [2] [5] [6] [7]. The safety and effectiveness of these conservative measures have not been established [2] [5] [6] [7]. Limited fasciectomy and limited dermofasciectomy are the techniques mostly used.