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Child Abuse: More Than Skin Deep

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Abstract

The skin is the most accessible organ of the human being. It is also the most frequently injured organ in accidents and in child abuse. Skin abnormalities are visible to everyone. The diagnosis of these abnormalities in suspected child abuse, however, is the work of specialists. Diagnostic errors can be prevented through close cooperation between forensic pediatrics and pediatric dermatology.

Ce qu’il y a de plus profond de l’homme, c’est la peau. (Paul Valery, French poet, 1871–1945)

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References

  • AlJasser M, Al-Khenaizan S. Cutaneous mimickers of child abuse: a primer for pediatricians. Eur J Pediatr. 2008;167(11):1221–30.

    Article  PubMed  Google Scholar 

  • Bays J. Conditions mistaken for child physical abuse. In: Reece RM, Ludwig S, editors. Child abuse, medical diagnosis and management. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 177–206.

    Google Scholar 

  • Bilo RAC. Forensic pediatric dermatology: my skin is only the toplayer of the problem. In: Oranje AP, de Waard – van der Spek FB, Bilo RAC. Dermatology from young to old. Zwolle: Isala series nr 43; 2003. p. 45–52.

    Google Scholar 

  • Bilo RAC, Oranje AP. Physiological habits, self-mutilation and factitious disorders. In: Harper J, Oranje A, Prose N, editors. Textbook of pediatric dermatology. 2nd ed. Oxford: Blackwell Publishing; 2006. p. 2096–109.

    Google Scholar 

  • Bilo RAC, Oranje AP, Shwayder T, Hobbs CJ. Cutaneous manifestations of child abuse and their differential diagnosis – blunt force trauma. New York: Springer; 2013.

    Book  Google Scholar 

  • Bouvet R, Pierre M, Toutain F, et al. Tufted angioma with Kasabach-Merritt syndrome mistaken for child abuse. Forensic Sci Int. 2014;245C:e15–7.

    Article  Google Scholar 

  • Boyd AS, Ritchie C, Likhari S. Munchausen syndrome and Munchausen syndrome by proxy in dermatology. J Am Acad Dermatol. 2014;71(2):376–81.

    Article  PubMed  Google Scholar 

  • Cantatore-Francis JL, Cohen-Pfeffer J, Balwani M, et al. Hepatoerythropoietic porphyria misdiagnosed as child abuse: cutaneous, arthritic, and hematologic manifestations in siblings with a novel UROD mutation. Arch Dermatol. 2010;146(5):529–33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Carlsen K, Weismann K. Phytophotodermatitis in 19 children admitted to hospital and their differential diagnoses: child abuse and herpes simplex virus infection. J Am Acad Dermatol. 2007;57(5 suppl):S88–91.

    Article  PubMed  Google Scholar 

  • Cyrulnik AA, Dawkins MC, Smalberger GJ, et al. Kaposiform hemangioendothelioma with Kasabach-Merritt syndrome mistaken for child abuse in a newborn. Cutis. 2014;93(3):E17–20.

    PubMed  Google Scholar 

  • Elder DE. Interpretation of anogenital findings in the living child: implications for the paediatric forensic autopsy. J Forensic Leg Med. 2007;14(8):482–8.

    Article  PubMed  Google Scholar 

  • Fortin K, Jenny C. Sexual abuse. Pediatr Rev. 2012;33(1):19–32.

    Article  PubMed  Google Scholar 

  • Harth W, Taube KM, Gieler U. Factitious disorders in dermatology [Article in English, German]. J Dtsch Dermatol Ges. 2010;8(5):361–72.

    PubMed  Google Scholar 

  • Harth W, Linse R. Dermatological symptoms and sexual abuse: a review and case reports. J Eur Acad Dermatol Venereol. 2000;14(6):489–94.

    Article  CAS  PubMed  Google Scholar 

  • Hobbs CJ, Hanks HGI, Wynne JM. Physical abuse. In: Hobbs CJ, Hanks HGI, Wynne JM, editors. Child abuse and neglect – a clinician’s handbook. 2nd ed. London/New York: Churchill Livingstone; 1999. p. 63–104.

    Google Scholar 

  • Hobbs CJ. Physical evidence of child sexual abuse. Eur J Pediatr. 2012;171(5):751–5.

    Article  PubMed  Google Scholar 

  • Hornor G. Common conditions that mimic findings of sexual abuse. J Pediatr Health Care. 2009;23(5):283–8.

    Article  PubMed  Google Scholar 

  • Johnson CF. Dermatological manifestations. In: Levin AV, Sheridan MS, editors. Munchausen syndrome by proxy – issues in diagnosis and treatment. New York: Lexington Books; 1995. p. 189–200.

    Google Scholar 

  • Kempe CH, Silverman FN, Steele BF, et al. The battered-child syndrome. JAMA. 1962;181:17–24.

    Article  CAS  PubMed  Google Scholar 

  • Kirschner RH, Stein RJ. The mistaken diagnosis of child abuse. A form of medical abuse? Am J Dis Child. 1985;139(9):873–5.

    Article  CAS  PubMed  Google Scholar 

  • Kotik A, Zaitsev K, Shperber A, Hiss J. [The prevalence of physical evidence in the anogenital area in sexual assault cases of children in Israel] [Article in Hebrew]. Harefuah. 2011;150(12):895–8, 936.

    PubMed  Google Scholar 

  • Libow JA. Child and adolescent illness falsification. Pediatrics. 2000;105(2):336–42.

    Article  CAS  PubMed  Google Scholar 

  • Oranje A, Bilo RA. Skin signs in child abuse and differential diagnosis. Minerva Pediatr. 2011;63(4):319–25.

    CAS  PubMed  Google Scholar 

  • Patnaik S, Mishra BR, Mohanty I, Nayak S. Foamy discharge on the scalp of the infant: Munchausen syndrome by proxy. Indian J Dermatol. 2013;58(5):410–1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ravanfar P, Dinulos JG. Cultural practices affecting the skin of children. Curr Opin Pediatr. 2010;22(4):423–31.

    Article  PubMed  Google Scholar 

  • Rosenberg DA. Munchausen syndrome by proxy. In: Reece RM, editor. Child abuse – medical diagnosis and management. Philadelphia: Lea Febiger; 1994. p. 266–78.

    Google Scholar 

  • Schreier HA, Libow JA. Munchausen by proxy syndrome: a modern pediatric challenge. J Pediatr. 1994;125:S110–5.

    Article  CAS  PubMed  Google Scholar 

  • Schwartz KA, Metz J, Feldman K, Sidbury R, Lindberg DM, the ExSTRA Investigators. Cutaneous findings mistaken for physical abuse: present but not pervasive. Pediatr Dermatol. 2014;31(2):146–55.

    Article  Google Scholar 

  • Stankler L. Factitious skin lesions in a mother and two sons. Br Med J. 1977;97:217.

    CAS  Google Scholar 

  • Stanziale SF, Christopher JC, Fisher RB. Brodifacoum rodenticide ingestion in a patient with shigellosis. South Med J. 1997;90(8):833–5.

    Article  CAS  PubMed  Google Scholar 

  • Sugandhan S, Gupta S, Khandpur S, et al. ‘Munchausen syndrome by proxy’ presenting as battered child syndrome: a report of two cases. Int J Dermatol. 2010;49(6):679–83.

    Article  PubMed  Google Scholar 

  • Swerdlin A, Berkowitz C, Craft N. Cutaneous signs of child abuse. J Am Acad Dermatol. 2007;57(3):371–92.

    Article  PubMed  Google Scholar 

  • Vennemann B, Perdekamp MG, Weinmann W, et al. A case of Munchausen syndrome by proxy with subsequent suicide of the mother. Forensic Sci Int. 2006;158(2–3):195–9.

    Article  CAS  PubMed  Google Scholar 

  • Weston WL, Morelli JG. “Painful and disabling granuloma annulare”: a case of Munchausen by proxy. Pediatr Dermatol. 1997;14(5):363–4.

    Article  CAS  PubMed  Google Scholar 

  • Wheeler DM, Hobbs CJ. Mistakes in diagnosing non-accidental injury, 10 years’ experience. Br Med J. 1988;296:1233–6.

    Article  CAS  Google Scholar 

  • WHO (World Health Organization). Preventing child maltreatment: a guide to taking action and generating evidence. Geneva: World Health Organization and International Society for Prevention of Child Abuse and Neglect; 2006.

    Google Scholar 

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Correspondence to Robert A. C. Bilo MD .

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Bilo, R.A.C. (2016). Child Abuse: More Than Skin Deep. In: Oranje, A., Al-Mutairi, N., Shwayder, T. (eds) Practical Pediatric Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-32159-2_16

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  • DOI: https://doi.org/10.1007/978-3-319-32159-2_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-32157-8

  • Online ISBN: 978-3-319-32159-2

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