Dermatological Emergencies: Skin Manifestations of Abuse

  • Rachel Nazarian
  • Joy Checa
  • Orit Markowitz


Abuse takes many forms, including physical abuse, sexual abuse, emotional abuse, and neglect. The definition of child abuse, by the Center for Prevention and Treatment of Child Abuse (USA), is stated as the mental and physical injury, sexual abuse, neglect, or mistreatment of individuals under 18 years of age, perpetrated by a caregiver, which indicates that the health of the child is threatened [1]. Physicians must always be alert for signs indicating any manifestation of abuse, looking for symptoms beyond skin lesions. The authors consider any form of abuse a medical emergency, recognizing that most children, or elderly, are unable to articulate their condition or alert authorities of any wrongdoing and rely nearly exclusively on the awareness of astute professionals. Many cases of abuse are left unrecognized by professionals, the findings being exceedingly subtle, often written off as innocuous lesions. Early recognition is crucial, not only to prevent subsequent injury which occurs in 30–70 % of children, but reports have indicated that abuse tends to increase in severity with time [2], and early intervention may avert these avoidable events.


Sexual Abuse Child Abuse Bacterial Vaginosis Lichen Planus Alopecia Areata 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Lyden C. Caring of the victim of child abuse in the pedriatric intensive care unit. Dimens Crit Care Nurs. 2009;28:61–6.PubMedGoogle Scholar
  2. 2.
    Purde GF, Hunt JL, Prescott PR. Child abuse by burning: an index of suspicion. J Trauma. 1988;28:221–4.CrossRefGoogle Scholar
  3. 3.
    Nong The Anh. ‘Pseudo-battered child’ syndrome. JAMA 1976;236:2288.Google Scholar
  4. 4.
    Peddle N, Wang C, Diaz J, Reid R. Current trends in child abuse reporting and fatalities: The results of the 2000 annual fifty state survey. Chicago: National Committee to Prevent Child Abuse; 2002.Google Scholar
  5. 5.
    Herman-Giddens ME, Brown G, Verbiest S, Carlson PJ, Hooten EG, Howell E, Butts JD. Underascertainment of child abuse mortality in the United States. JAMA. 1999;282(5):463–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Feldman W, Feldman E, Goodman JT, McGrath PJ, Pless RP, Corsini L, Bennett S. Is childhood sexual abuse really increasing in prevalence? An analysis of the evidence. Pediatrics. 1991;88(1):29–33.PubMedGoogle Scholar
  7. 7.
    Gondim RM, Muñoz DR, Petri V. Child abuse: skin markers and differential diagnosis. An Bras Dermatol. 2011;86(3):527–36.PubMedCrossRefGoogle Scholar
  8. 8.
    Hanson RF, Resnick HS, Saunders BE, Kilpatrick DG, Best C. Factors related to the reporting of childhood sexual assault. Child Abuse Negl. 1999;23:559–69.PubMedCrossRefGoogle Scholar
  9. 9.
    Hopper J. Child sexual abuse: statistics, research. Boston, MA: Boston University School of Medicine Resources; 1998.Google Scholar
  10. 10.
    Lanier P, Jonson-Reid M, Stahlschmidt MJ, Drake B, Constantino J. Child maltreatment and pediatric health outcomes: a longitudinal study of low-income children. J Pediatr Psychol. 2010;35(5):511–22. Epub 2009 Oct 1.PubMedCrossRefGoogle Scholar
  11. 11.
    Goodwin RD, Stein MB. Association between childhood trauma and physical disorders among adults in the United States. Psychol Med. 2004;34(3):509–20.PubMedCrossRefGoogle Scholar
  12. 12.
    Kearney CA, Wechsler A, Kaur H, Lemos-Miller A. Posttraumatic stress disorder in maltreated youth: a review of contemporary research and thought. Clin Child Fam Psychol Rev. 2010;13:46–76.PubMedCrossRefGoogle Scholar
  13. 13.
    Kos L, Shwayder T. Cutaneous manifestations of child abuse. Pediatr Dermatol. 2006;23:311–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Hettler J, Greenes DS. Can the initial history predict whether a child with a head injury has been abused? Pediatrics. 2003;111:602–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Swerdlin A, Berkowitz C, Craft N. Cutaneous signs of child abuse. J Am Acad Dermatol. 2007;57:371–92.PubMedCrossRefGoogle Scholar
  16. 16.
    Chadwick DL. The diagnosis of inflicted injury in infants and young children. Del Med J. 1997;69:345–54.PubMedGoogle Scholar
  17. 17.
    van Rijn RR, Sieswerda-Hoogendoorn T. Educational paper: imaging child abuse: the bare bones. Eur J Pediatr. 2012;172(2):215–24 [Epub ahead of print].CrossRefGoogle Scholar
  18. 18.
    Hobbs CJ, Hanks HGI, Wynne JM. Child abuse and neglect: a clinician’s handbook. 2nd ed. London: Churchill Livingstone; 1999.Google Scholar
  19. 19.
    Zolotor AJ, Robinson TW, Runyan DK, Barr RG, Murphy RA. The emergence of spanking among a representative sample of children under 2 years of age in North Carolina. Front Psychiatry. 2011;2:36. Epub 2011 Jun 24.PubMedCrossRefGoogle Scholar
  20. 20.
    Mimasaka S, Ohtani M, Kuroda N, Tsunenari S. Spectrophotometric evaluation of the age of bruises in children: measuring changes in bruise color as an indicator of child physical abuse. J Exp Med. 2010;220(2):171–5.Google Scholar
  21. 21.
    Toon MH, Maybauer DM, Arceneaux LL, Fraser JF, Meyer W, Runge A, Maybauer MO. Children with burn injuries-assessment of trauma, neglect, violence and abuse. J Inj Violence Res. 2011;3(2):98–110.PubMedCrossRefGoogle Scholar
  22. 22.
    Stratman E, Melski J. Scald abuse. Arch Dermatol. 2002;138(3):318–20.PubMedCrossRefGoogle Scholar
  23. 23.
    Maguire S, Moynihan S, Mann M, Potokar T, Kemp AM. A systematic review of the features that indicate intentional scalds in children. Burns. 2008;34(8):1072–81. Epub 2008 Jun 6.PubMedCrossRefGoogle Scholar
  24. 24.
    Shavit I, Knaani-Levinz H. Images in emergency medicine. Child abuse caused by cigarette burns. Ann Emerg Med. 2008;51(5):579. 582.PubMedCrossRefGoogle Scholar
  25. 25.
    Hobbs CJ. ABC of child abuse. Burns and scalds. BMJ. 1989;298(6683):1302–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Yeoh C, Nixon JW, Dickson W, Kemp A, Sibert JR. Patterns of scald injuries. Arch Dis Child. 1994;71:186–8.CrossRefGoogle Scholar
  27. 27.
    Renz BM, Sherman R. Abusive scald burns in infants and children: a prospective study. Am Surg. 1993;59:329–34.PubMedGoogle Scholar
  28. 28.
    Ermertcan AT, Ertan P. Skin manifestations of child abuse. Indian J Dermatol Venereol Leprol. 2010;76(4):317–26.PubMedCrossRefGoogle Scholar
  29. 29.
    Bell TA, Stamm WE, Wang SP, Holmes KK, Grayston JT. Chronic Chlamydia trachomatis infections in infants. JAMA. 1992;267:400–2.PubMedCrossRefGoogle Scholar
  30. 30.
    Hammerschlag MR, Cummings M, Doraiswamy B, Cox P, McCormack WM. Nonspecific vaginitis following sexual abuse in children. Pediatrics. 1985;75:1028–31.PubMedGoogle Scholar
  31. 31.
    Marcoux D, Nadeau K, McCuaig C, Powell J, Oligny LL. Pediatric anogenital warts: a 7-year review of children admitted to a tertiary-care hospital in Montreal. Can Pediatr Dermatol. 2006;23:199–207.CrossRefGoogle Scholar
  32. 32.
    Handley J, Hanks E, Armstrong K, Bingham A, Dinsmore W, Swann A, Evans MF, McGee JO, O’Leary J. Common association of HPV 2 with anogenital warts in prepubertal children. Pediatr Dermatol. 1997;14:339–43.PubMedCrossRefGoogle Scholar
  33. 33.
    Pinheiro Rdos S, de França TR, Ferreira Dde C, Ribeiro CM, Leão JC, Castro GF. Human papillomavirus in the oral cavity of children. J Oral Pathol Med. 2011;40(2):121–6. doi: 10.1111/j.1600-0714.2010.00954.x. Epub 2010 Oct 24.PubMedCrossRefGoogle Scholar
  34. 34.
    Schilling S, Wood JN, Levine MA, Langdon D, Christian CW. Vitamin D status in abused and nonabused children younger than 2 years old with fractures. Pediatrics. 2011;127(5):835–41. Epub 2011 Apr 11.PubMedCrossRefGoogle Scholar
  35. 35.
    Kemp A, Maguire SA, Sibert J, Frost R, Adams C, Mann M. Can we identify abusive bites on children? Arch Dis Child. 2006;91(11):951.PubMedCrossRefGoogle Scholar
  36. 36.
    Bernitz H, Owen JH, van Heerden WF, Solheim T. An integrated technique for the analysis of skin bite marks. J Forensic Sci. 2008;53(1):194–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Seifert D, Püschel K. Subgaleal hematoma in child abuse. Forensic Sci Int. 2006;157(2–3):131–3. Epub 2005 Sep 26.PubMedCrossRefGoogle Scholar
  38. 38.
    Isaac R, Lyn M, Triggs N. Lichen sclerosus in the differential diagnosis of suspected child abuse cases. Pediatr Emerg Care. 2007;23(7):482–5.PubMedCrossRefGoogle Scholar
  39. 39.
    AlJasser M, Al-Khenaizan S. Cutaneous mimickers of child abuse: a primer for pediatricians. Eur J Pediatr. 2008;167(11):1221–30. Epub 2008 Jul 26.PubMedCrossRefGoogle Scholar
  40. 40.
    Oates RK. Overturning the diagnosis of child abuse. Arch Dis Child. 1984;59(7):665–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Leung AK, Robson WL. Superimposed Mongolian spots. Pediatr Dermatol. 2008;25(2):233–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Barzilai A, Choen HA. Isolation of group A streptococci from children with perianal cellulitis and from their siblings. Pediatr Infect Dis J. 1998;17:358–60.PubMedCrossRefGoogle Scholar
  43. 43.
    Duhra P, Ilchyshyn A. Perianal streptococcal cellulitis with penile involvement. Br J Dermatol. 1990;123(6):793–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Byard RW, Donald TG, Rutty GN. Non-traumatic causes of perianal hemorrhage and excoriation in the young. Forensic Sci Med Pathol. 2008;4(3):159–63. Epub 2008 Jan 9.PubMedCrossRefGoogle Scholar
  45. 45.
    Berth-Jones J, Graham-Brown RA, Burns DA. Lichen sclerosus et atrophicus—a review of 15 cases in young girls. Clin Exp Dermatol. 1991;16(1):14–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Mataix J, Belinchón I, Bañuls J, Pastor N, Betlloch I. Skin lesions from the application of suction cups for therapeutic purposes. Actas Dermosifiliogr. 2006;97(3):212–4.PubMedCrossRefGoogle Scholar
  47. 47.
    Asnes RS, Wisotsky DH. Cupping lesions simulating child abuse. J Pediatr. 1981;99(2):267–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Look KM, Look RM. Skin scraping, cupping, and moxibustion that may mimic physical abuse. J Forensic Sci. 1997;42(1):103–5. Review.PubMedGoogle Scholar
  49. 49.
    Wong HC, Wong JK, Wong NY. Signs of physical abuse or evidence of moxibustion, cupping or coining? CMAJ. 1999;160(6):785–6.PubMedGoogle Scholar
  50. 50.
    Ravanfar P, Dinulos JG. Curr Opin Pediatr. Cultural practices affecting the skin of children. 2010;22(4):423–31. Review.Google Scholar
  51. 51.
    Morris R, Usatine R. An unusual pattern of bruising. West J Med. 2000;172(5):298.PubMedCrossRefGoogle Scholar
  52. 52.
    Dumaret AC, Tursz A. Long-term consequences of child abuse and neglect. Rev Prat. 2011;61(5):663–6.PubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2013

Authors and Affiliations

  1. 1.Department of DermatologyMt. Sinai HospitalNew YorkUSA
  2. 2.American University of the Caribbean School of MedicineCoral SpringsUSA
  3. 3.Faculty Practice Associates-DermatologyNew YorkUSA

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