Viero and colleagues recently proposed an interesting review that pointed out the most important features of skin lesions caused by traditional folk practices . The aim of their paper was to identify useful indications for a correct differential diagnosis of suspected cases of abuse and skin findings due to traditional medicine and cultural practices . It is important to note that the aforementioned review is based on a crucial precondition: according to the authors, the identification of physical signs of traditional medicine practices should exclude a suspected abuse; indeed, the authors pointed out that these physical signs are not the result of abusive behaviors . Nevertheless, the latter precondition is questionable for the following reasons: traditional medicine practices are frequently not performed by healthcare professionals, folk medicine techniques are not always based on the scientific conception of therapy, the aforementioned practices can determine adverse effects (such as bruises, burns, bleeding, panniculitis, contact dermatitis, etc.), especially when they are performed in inadequate settings [1,2,3]. Moreover, it is important to point out that most of the papers reviewed by Viero and colleagues dealt with living children . Because underage people cannot express a valid consent, parents have the responsibility of cutaneous or systemic adverse effects caused by folk medicine techniques that are not performed by healthcare professionals and that are executed in inadequate settings. In addition, it is important to note that the World Health Organization defined child abuse as follows: “Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power” . Therefore, it is clear that in a child the occurrence of skin lesions due to traditional medicine may be the result of abusive behaviors. This may happen when there are no medical indications for the execution of the aforementioned practices, these techniques are performed in inadequate settings by people who are not healthcare professionals, and adverse effects occur.
In the light of the above, it can be stated that the occurrence of skin lesions due to traditional medicine and cultural practices should not always exclude child abuse. The final decision to report such lesions should be based on a careful multidisciplinary evaluation .
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Tsokos M. Diagnostic criteria for cutaneous injuries in child abuse: classification, findings, and interpretation. Forensic Sci Med Pathol. 2015;11:235–42.
Wiwanitkit V. Culture-bounded skin lesion - a case due to Chinese Gua Sha. Indian J Dermatol. 2017;62:441.
World Health Organisation, Geneva Report of the consultation on child abuse prevention, 29–31 March 1999. 1999. https://apps.who.int/iris/handle/10665/65900.
Curti SM, Lupariello F, Coppo E, Praznik EJ, Racalbuto SS, Di vella G. Child sexual abuse perpetrated by women: case series and review of the literature. J Forensic Sci. 2019. https://doi.org/10.1111/1556-4029.14033.
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Lupariello, F. Child abuse and traditional medicine practices. Forensic Sci Med Pathol 16, 203 (2020). https://doi.org/10.1007/s12024-019-00160-z