Millipede burn at an unusual site mimicking child abuse in an 8-year-old girl

A Systematic Review of Pediatric Nonaccidental Burns: Protecting the Children Through Knowledge, Vigilance, and Prevention

BACKGROUND

Inflicted burns on children are a particularly difficult medical and psychosocial issue. Pediatric nonaccidental burns (PNABs) are unfortunately relatively common. In our study, we aim to present the key findings on PNABs with the intention of raising awareness, improving early, and recognizing accurately by identifying red flags, developing triage tools, and establishing prevention strategies for this sensitive issue.

METHODS

A computerized literature search was conducted on PubMed, Google Scholar, and Cochrane for articles published until November 2020. The online screening process was performed by 3 independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO).

RESULTS

A total of 12 studies were included for analysis. Scald burns via forced immersion accounted for the majority of reported PNABs affecting both feet and hands. Complications included wound infection, sepsis, requiring systemic antibiotics, or intensive care. Abused children's parents had a history of mental illness, unemployment, substance abuse, incarceration, and/or low annual income.

CONCLUSIONS

Scalds via forced immersion remain the most common mechanism of PNABs. All health care professionals must remain vigilant, be able to recognize subtle signs of abuse, triage patients appropriately, report to police and/or social services, and ensure no further harm is made to the child or children. Repeated abuse with burns can lead to death. Prevention and education are the cornerstones for addressing this social phenomenon.

Cutaneous Mimics of Child Abuse & Neglect: Part II

Given that some cutaneous mimics of child abuse result from rare disease, they may be more prone to misdiagnosis. For possible child abuse cases in which diagnosis remains uncertain at time of initial dermatologic evaluation, it is important that dermatologists are prepared to distinguish true dermatologic conditions in cases of ambiguous skin findings. Additionally, this review will aid clinicians in recognizing the possibility of concurrent true dermatologic disease and skin findings related to abuse with the acknowledgement that they are not mutually exclusive. Proper recognition of mimics of abuse may prevent unnecessary stress and child protective service investigation.

Human accidents involving Rhinocricus spp., a common millipede genus observed in urban areas of Brazil

OBJECTIVE

The most important millipede species causing accidents in Brazil is Rhinocricus padbergi (order Spirobolida, family Rhinocricidae), a vegetarian scavenger distributed from Central to South America. Eleven clinical cases of dermal and oral accidental exposures to secretions from Rhinocricus spp. milipedes are described.

CASE SERIES

Eleven cases of skin and oral involvement after accidental contact with the secretions of Rhinocricus spp. in patients from 1to 46 years are detailed. Ten of the 11 accidents involved the feet and in 1 child the mouth. Mild pain was reported in two of the cases, and a transient local burning sensation was described by most of the patients. Three reported no pain or any sensation at all. What was observed in all patients was a dark reddish or blackish staining of the skin simulating inflammatory or even necrotic lesions, which resolved naturally after some weeks.

CONCLUSION

Despite the necrotic appearance of Rhinocricus spp. skin lesions, only a very mild inflammation and no necrosis occur. Analysis of the content of 50 glands of these animals captured in the southeast region of Brazil identified 2-methil-1,4-benzoquinone and 3,3a,4,5-tetrahydro-1H-pyrrolo-[2,3-b] pyridine-2,6-dione as the substances responsible for the lesions. Benzoquinones are strongly irritant and persistent compounds, working very well as insect repellents and are toxic to a great variety of other parasites and pathogens. They also have tanning properties. No systemic toxic effects have been described so far after skin contact with benzoquinones or Rhinocricus species.