Abuse at a Glance
- Child abuse, elder abuse, and domestic violence are common.
- Abuse is a problem of all socioeconomic classes and races.
- Bruising on soft padded areas of the body and patterned bruising that are multiple and in different stages of healing are suspicious of abuse.
- Burns that are bilateral and uniform are suspicious of abuse.
- Law mandates the reporting of all suspected cases of child abuse and, in some states, elder abuse.
Child abuse is an uncomfortable topic for most practitioners and is a source of anxiety, anger, and confusion among those who care for children. True incidence statistics are difficult to determine, but each year in the United States, of the approximately three million children referred to child protective services, approximately one million are determined to be the victims of abuse and neglect (or about 12 cases per 1,000 children) and approximately 1,500 die from abuse or neglect.1 Clearly, those whose practices involve the dermatologic care of children encounter real or suspected child abuse. Practitioners must have some basic knowledge of abuse and its evaluation to appropriately manage these cases.
Because many forms of physical abuse have external manifestations, the skin examination may serve as the first clue that abuse is taking place. Conversely, a broad knowledge of skin diseases provides a unique insight into those diagnoses that may mimic various forms of child abuse (Tables 106-1 and 106-2). The literature is rich in examples in which an astute clinician averted the disastrous results of a false claim of abuse by correctly diagnosing a dermatologic condition.
Table 106-1 Conditions Mistaken for Abusive Bruising |Favorite Table|Download (.pdf)
Table 106-1 Conditions Mistaken for Abusive Bruising
- True petechiae and purpura
- Disorders of coagulation
- Ehlers–Danlos syndrome
- Rocky Mountain spotted fever
- Meningococcal infections
- Group A streptococcal infections
- Palpable purpura of vasculitis
- Valsalva petechiae
- Lichen sclerosus
- Folk remedies
- Cao gio: rubbing vigorously with a hard object such as a coin
- Cupping: suction mark left by the cooling of a warm metal cup
- Nodular lesions mimicking deep bruises
- Vascular malformations
- Dermatomyositis-associated nodules
- Erythema nodosum
- Discolorations that look like bruises
- Maculae coeruleae from lice infestation
- Mongolian spots
- Dye from blue jeans
- Inflammatory conditions that mimic bruising
- Urticaria/angioedema/urticarial vasculitis
- Conditions that mimic whip marks
- Incontinentia pigmenti
Table 106-2 Conditions Mistaken for Nonaccidental Burns |Favorite Table|Download (.pdf)
Table 106-2 Conditions Mistaken for Nonaccidental Burns
- Folk remedies (Maquas, or moxibustion): burns delivered near diseased organs or therapeutic sites as in acupuncture
- Epidermolysis bullosa
- Immunobullous diseases
- Sunburn/xeroderma pigmentosum
- Burns from objects heated by sun
- Electric burn from an enuresis blanket
- Chemical burn from use of undiluted acetic acid
- Chemical burn from Icy Hot balm
- Chemical burn from calcium chloride
- Diaper dermatitis
- Fixed drug eruption
True abuse must be reported and ...