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Exogenous skin disorders

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

Drug induced conditions: mimickers of intentional burns

Cetirimide reaction 2,4

  • One case to the perineum and upper thigh4 and one to the anterior chest2, both aggravated by the area being occluded

Laxative induced dermatitis 3

  • Four cases who had ingested commercial laxative – leading to diarrhoea and sharply demarcated area of erythema with multiple bullous lesions over buttocks
  • Extended 5 cm from anus, sparing skin around anus and perineum in ¾ cases
  • Continued to extend to precise limits of the nappy
  • Lesions progressed from blisters to large bullae

Caustic burn 1

  • Single case of partial thickness burn due to laundry detergent on medial aspect of thigh
  • Delayed presentation 

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References

  1. Howieson AJ, Harley OJH, Tiernan EP. Laundry detergent and possible nonaccidental injury. European Journal of Emergency Medicine. 2007;14(3):163-164 [Pubmed]
  2. Inman JK. Cetrimide allergy presenting as suspected non-accidental injury. British Medical Journal. 1982;284(6313):385 [Pubmed citation only]
  3. Leventhal JM, Griffin D, Duncan KO, Starling S, Christian CW, Kutz T. Laxative-induced dermatitis of the buttocks incorrectly suspected to be abusive burns. Pediatrics. 2001;107(1):178-179 [Pubmed citation only]
  4. Mercer DM. Cetrimide burn in an infant. Postgraduate Medical Journal. 1983;59(693):472-473 [Pubmed citation only]

Pressure / friction injuries 1

  • Four cases, mistaken for burns, all had U-shaped curvilinear marks on the backs of their legs
  • One case was matched to a swing seat; one to the upper margin of boots; two felt to be pressure injuries
  • Remarkably similar descriptions and course to congenital curvilinear palpable hyperpigmentation

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References

  1. Feldman KW. Confusion of innocent pressure injuries with inflicted dry contact burns. Clinical Pediatrics. 1995;34(2):114-115 [Pubmed citation only]

Unintentional electrical burns 1

  • A seven-year-old using an enuresis blanket; 5mm papules and ulcers distributed linearly on the dorsal aspect of the right forearm – due to faulty enuresis blanket

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References

  1. Diez F, Berger TG. Scarring due to an enuresis blanket. Pediatric Dermatology. 1988;5(1):58-60 [Pubmed]

Unintentional contact burns 1

  • Four cases from walking on very hot surfaces
  • Burns to the plantar surface of the foot

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References

  1. Sinha M, Salness R, Foster KN, Fenn R, Hannasch C. Accidental foot burns in children from contact with naturally heated surfaces during summer months: experience from a regional burn center. Journal of Trauma Injury Infection & Critical Care. 2006;61(4):975-978 [Pubmed]

Insect lesions

  • Three post-mortem cases 2 where there were sudden unexplained deaths and what appeared to be multiple superficial skin lesions on exposed skin (arms, face, neck, legs) due to cockroaches eating skin. These lesions were with burns.
  • Two live cases 1,3 noted to have unexplained curvilinear marks, brownish-red in hue – caused by millipede inside clothing.  Swelling and tenderness may be present.

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References

  1. Dar NR, Raza N, Rehman SB. Millipede burn at an unusual site mimicking child abuse in an 8-year-old girl. Clinical Pediatrics. 2008;47(5):490-492 [Pubmed citation only]
  2. Denic N, Huyer DW, Sinal SH, Lantz PE, Smith CR, Silver MM. Cockroach: the omnivorous scavenger. Potential misinterpretation of postmortem injuries. American Journal of Forensic Medicine and Pathology. 1997;18(2):177-180 [Pubmed]
  3. Girardin BW, Stevenson S. Millipedes: health consequences. Journal of Emergency Nursing. 2002;28(2):107-110 [Pubmed citation only]

Photodermatitis

Sun exposure following chemical contact elicits skin lesions:

Location and agent:

  • Buttocks due to rue 5
  • Face and neck due to perfume 1,4
  • Dripping pattern over cheeks, chin, upper chest, backs of hands and red streaks down front of chest due to lime juice 3
  • Linear blistering lesions to shoulders and back due to wild parsnip 2
  • Shoulders and arms due to citrus drink being thrown at child 1
  • Forearm, shin, face and chin due to plant exposure 6

Characteristics:

  • Initial redness leading to blistering lesions which follow the pattern of contact with plant / psoralen 
  • All had sun exposure following chemical contact 
  • All lesions appeared to occur spontaneously 
  • All appeared on sun-exposed area of skin 
  • May be delayed presentation

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References

  1. Botash AS, Sveen AR, Frasier LD. Child abuse—or mimic? Is there a medical explanation? Possible burns in two children. Consultant. 2004;44(2):232-237 [Extract from cancernetwork.com]
  2. Campbell AN, Cooper CE, Dahl MGC. "Non-accidental injury" and wild parsnips. British Medical Journal. 1982;284(6317):708 [Pubmed citation only]
  3. Dannaker CJ, Glover RA, Goltz RW. Phytophotodermatitis: A mystery case report. Clinical Pediatrics. 1988;27(6):289-290 [Pubmed citation only]
  4. Gruson LM, Chang MW. Berloque dermatitis mimicking child abuse. Archives of Pediatric and Adolescent Medicine. 2002;156(11):1091-1093 [Pubmed]
  5. Hill P, Pickford M, Parkhouse N. Phytophotodermatitis mimicking child abuse. The Journal of the Royal Society of Medicine. 1997;90(10):560-561 [Pubmed]
  6. Mehta AJ, Statham BN. Phytophotodermatitis mimicking non-accidental injury or self-harm. European Journal of Pediatrics. 2007;166(7):751-752 [Pubmed citation only]

Infections

Staphylococcal scalded skin syndrome – two cases 1

  • Case One had 8mm ulceration on forehead, 15mm x 35mm lesion on left cheek and 15mm x 18mm lesion on abdomen, with new lesions appearing over next few days 
  • Case Two had bullous lesions to trunk, thorax, genitalia, right upper limb, back and left cheek, with new lesions appearing over following days 
  • Culture was positive for staphylococcus aureus in both cases

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References

  1. Porzionato A, Aprile A. Staphylococcal scalded skin syndrome mimicking child abuse by burning. Forensic Science International. 2007;168(1):e1-e4 [Pubmed]

Bullous impetigo

  • Two cases 1,2, both occurred “de novo”
  • In one case 2, lesions in areas of skin that were touching one another

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References

  1. Grellner W, Metzner G. Kindesmißhandlung durch thermische Gewalt: Abgrenzung und Rekonstruktion [German] [Child abuse caused by thermal violence--determination and reconstruction]. Archiv für Kriminologie. 1995;195(1):38-46 [Pubmed]
  2. Oates RK. Overturning the diagnosis of child abuse. Archives of Disease in Childhood. 1984;59(7):665-666 [Pubmed]

Toxic shock 1

  • Single case; systemically ill for two weeks
  • Multiple circular lesions on back, thought to be cigarette burns
  • Erythema in a number of areas 
  • Died of toxic shock; diagnosis confirmed on microbiology

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References

  1. Nields H, Kessler SC, Boisot S, Evans R. Streptococcal toxic shock syndrome presenting as suspected child abuse. The American Journal of Forensic Medicine and Pathology. 1998;19(1):93-97 [Pubmed]

Tinea Capitis 1

  • Single case; ten-year-old; back of scalp

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References

  1. Loh N, Porter W, Webb M. The obvious 'non-accidental injury'. Irish Medical Journal. 2005;98(7):217-218 [Pubmed citation only]

 

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