Skin lesions and traditional folk practices: a medico-legal perspective
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Abstract
The correct assessment of signs of abuse on the skin is a challenge of utmost importance for both clinical and forensic applications. This review aims to investigate how differing cultural behaviors influence the perception of abuse, focusing on the need for a multidisciplinary approach and investigation. A literature search for articles that discussed folk practices from a forensic perspective was performed; articles with reference to abuse in the description of the main folk healing techniques and with reference to the differential diagnosis between physical abuse and skin injuries due to folk healing techniques were selected. A synoptic table of all skin injuries produced by folk healing techniques, divided by geographical area, was created. This table can be used as a tool for the thorough assessment of typical signs detectable on the skin, thus aiding in a differential diagnosis. The first approach to the patient represents a crucial step toward the identification of abuse; forensic practitioners ought to be aware of the existence of folk healing techniques which may mimic signs that can be interpreted as physical abuse in children and adults.
Keywords
Clinical forensic medicine Physical abuse Bruising Folk healing techniques Differential diagnosisNotes
Compliance with ethical standard
Conflict of interest
None of the authors have conflicts of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
Informed consent the article does not contain any studies with human participants requesting their informed consent.
References
- 1.Chadwick DL. The diagnosis of inflicted injury in infants and young children. Pediatr Ann. 1992;21:477–83.CrossRefGoogle Scholar
- 2.Ellis P. Cutaneous findings in children. In: Collins KA, Byard RW, editors. Forensic pathology of infancy and childhood. New York: Springer; 2014. p. 243–65.CrossRefGoogle Scholar
- 3.Li YMM, Wells D. Skin conditions mimicking pediatric inflicted injury. In: Collins KA, Byard RW, editors. Forensic pathology of infancy and childhood. New York: Springer; 2014. p. 267–89.Google Scholar
- 4.Bilo RA. Skin signs in child abuse and differential diagnosis. Minerva Pediatr. 2011;63:319–25.PubMedGoogle Scholar
- 5.Vashi NA, Patzelt N, Wirya S, Maymone MBC, Zancanaro P, Kundu RV. Dermatoses caused by cultural practices: therapeutic cultural practices. J Am Acad Dermatol. 2018;79:1–16.CrossRefGoogle Scholar
- 6.Marion T, Cao K, Roman J. Gua Sha, or coining therapy. JAMA Dermatol. 2018;154:788.CrossRefGoogle Scholar
- 7.Wiwanitkit V. Culture-bounded skin lesion - a case due to Chinese Gua Sha. Indian J Dermatol. 2017;62:441.CrossRefGoogle Scholar
- 8.Tanner BS, Catanese C, Lew EO, Rapkiewicz A. Pitfalls in the interpretation of traumatic socioethnic practices. J Forensic Sci. 2016;61:569–72.CrossRefGoogle Scholar
- 9.Tsokos M. Diagnostic criteria for cutaneous injuries in child abuse: classification, findings, and interpretation. Forensic Sci Med Pathol. 2015;11:235–42.CrossRefGoogle Scholar
- 10.Aprile A, Pomara C, Turillazzi E. Gua Sha a traditional Chinese healing technique that could mimick physical abuse: a potential issue with forensic implications. A case study. Forensic Sci Int. 2015;249:e19–20.CrossRefGoogle Scholar
- 11.Li Z, Huan Z, Byard RW. Bruising caused by traditional Chinese massage therapy (Ba sha) complicating the assessment of a case of fatal child abuse. J Forensic Legal Med. 2015;36:49–51.CrossRefGoogle Scholar
- 12.Odhav A, Patel D, Stanford CW, Hall JC. Report of a case of Gua Sha and an awareness of folk remedies. Int J Dermatol. 2013;52:892–3.CrossRefGoogle Scholar
- 13.Lilly E, Kundu RV. Dermatoses secondary to Asian cultural practices. Int J Dermatol. 2012;51:372–9 quiz 379-82.CrossRefGoogle Scholar
- 14.Tan A, Mallika P. Coining: an ancient treatment widely practiced among asians. Malays Fam Physician. 2011;6:97–8.PubMedPubMedCentralGoogle Scholar
- 15.Harris TS. Bruises in children: normal or child abuse? J Pediatr Health Care. 2010;24:216–21.CrossRefGoogle Scholar
- 16.Ravanfar P, Dinulos JG. Cultural practices affecting the skin of children. Curr Opin Pediatr. 2010;22:423–31.CrossRefGoogle Scholar
- 17.Ribeiro CS, Rodrigues F, Ribeiro C, Magalhães T. A case report for differential diagnosis: integrative medicine vs child abuse. Leg Med (Tokyo). 2010;12:316–9.CrossRefGoogle Scholar
- 18.Allen SA, Janjua M, Badshah A. An unusual pattern of ecchymosis related to Gua Sha. Wien Klin Wochenschr. 2009;121:684.CrossRefGoogle Scholar
- 19.Nielsen A. Gua sha research and the language of integrative medicine. J Bodyw Mov Ther. 2009;13:63–72.CrossRefGoogle Scholar
- 20.Swerdlin A, Berkowitz C, Craft N. Cutaneous signs of child abuse. J Am Acad Dermatol. 2007;57:371–92.CrossRefGoogle Scholar
- 21.Kos L, Shwayder T. Cutaneous manifestations of child abuse. Pediatr Dermatol. 2006;23:311–20.CrossRefGoogle Scholar
- 22.Heymann WR. Cutaneous signs of child abuse. J Am Acad Dermatol. 2005;53:138–9.CrossRefGoogle Scholar
- 23.Mudd SS, Findlay JS. The cutaneous manifestations and common mimickers of physical child abuse. J Pediatr Health Care. 2004;18:123–9.CrossRefGoogle Scholar
- 24.Flores G, Rabke-Verani J, Pine W, Sabharwal A. The importance of cultural and linguistic issues in the emergency care of children. Pediatr Emerg Care. 2002;18:271–84.CrossRefGoogle Scholar
- 25.Rampini SK, Schneemann M, Rentsch K, Bächli EB. Camphor intoxication after cao gío (coin rubbing). JAMA. 2002;288:45.CrossRefGoogle Scholar
- 26.Davis RE. Cultural health care or child abuse? The southeast Asian practice of cao gio. J Am Acad Nurse Pract. 2000;12:89–95.CrossRefGoogle Scholar
- 27.Wong HC, Wong JK, Wong NY. Signs of physical abuse or evidence of moxibustion, cupping or coining? CMAJ. 1999;160:785–6.PubMedPubMedCentralGoogle Scholar
- 28.Hansen KK. Folk remedies and child abuse: a review with emphasis on caida de mollera and its relationship to shaken baby syndrome. Child Abuse Negl. 1998;22:117–27.CrossRefGoogle Scholar
- 29.Look KM, Look RM. Skin scraping, cupping, and moxibustion that may mimic physical abuse. J Forensic Sci. 1997;42:103–5.CrossRefGoogle Scholar
- 30.Uba L. Cultural barriers to health care for southeast Asian refugees. Public Health Rep. 1992;107:544–8.PubMedPubMedCentralGoogle Scholar
- 31.Buchwald D, Panwala S, Hooton TM. Use of traditional health practices by southeast Asian refugees in a primary care clinic. West J Med. 1992;156:507–11.PubMedPubMedCentralGoogle Scholar
- 32.Rosenblat H, Hong P. Coin rolling misdiagnosed as child abuse. CMAJ. 1989;140:417.PubMedPubMedCentralGoogle Scholar
- 33.Muecke MA. Caring for southeast Asian refugee patients in the USA. Am J Public Health. 1983;73:431–8.CrossRefGoogle Scholar
- 34.Asnes RS, Wisotsky DH. Cupping lesions simulating child abuse. J Pediatr. 1981;99:267–8.CrossRefGoogle Scholar
- 35.Tan A. Coin rubbing and related folk medicine. JAMA. 1981;245:1819.CrossRefGoogle Scholar
- 36.Du JN. Pseudobattered child syndrome in Vietnamese immigrant children. Can Med Assoc J. 1980;122:394–5.PubMedPubMedCentralGoogle Scholar
- 37.Primosch RE, Young SK. Pseudobattering of Vietnamese children (cao gio). J Am Dent Assoc. 1980;101:47–8.CrossRefGoogle Scholar
- 38.Yeatman GW, Dang VV. Cao Gío (coin rubbing). Vietnamese attitudes toward health care. JAMA. 1980;244:2748–9.CrossRefGoogle Scholar
- 39.Keller EL, Apthorp J. Folk remedies vs child battering. Am J Dis Child. 1977;131:1173.CrossRefGoogle Scholar
- 40.Yeatman GW, Shaw C, Barlow MJ, Barlett G. Pseudobattering in Vietnamese children. Pediatrics. 1976;58:616–8.PubMedGoogle Scholar
- 41.Nong The Anh. “Pseudo-battered child” syndrome. JAMA. 197615;236:2288.Google Scholar