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Zeidan NA, Bukhamseen FM, Al-Qassab AT, Alsadah FZ, Menezes RG. Cutaneous mimickers of physical child abuse: A brief overview. Med Leg J 2023; 91:26-29. [PMID: 35156441 DOI: 10.1177/00258172211062295] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Child abuse is one of the medico-legal issues a physician may face during his/her clinical practice. It has devastating effects on both the child and family, especially psychological. If falsely identified as a child abuse case, it could result in detrimental consequences. Therefore, physicians must recognise and be able to rule out child abuse mimickers, which are often conditions that are mistakenly confused with true physical child abuse. Injuries like bruises and burns are common presentations and therefore it is important to consider cutaneous abuse mimics to avoid incorrect diagnosis of child abuse. This review article sheds light on the most common cutaneous conditions that can mimic physical child abuse, where patients present with patterns of various skin lesions that raise a suspicion of child abuse.
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Affiliation(s)
- Nehal A Zeidan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah M Bukhamseen
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aqilah T Al-Qassab
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Z Alsadah
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ritesh G Menezes
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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2
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Abstract
Child sexual abuse (CSA) is defined as inappropriate adolescent or adult sexual behavior or contact with a child. Sexual abuse may be committed by any person including those under the age of 18 years when that person is either significantly older than the victim or is in a position of power or control over the child. Detecting CSA requires a high incidence of suspicion and familiarity with physical, behavioral, and verbal indications of abuse. Shame and guilt often may have discussion difficult. Studies have shown that approximately 60% of abused children have injuries to head, face, and mouth. Some of the oral and dental features that may be commonly noted in CSA are bruised lips, lacerated mucosa, nonexplainable missing teeth, tongue or frenal injuries, bone fractures in maxillofacial complex, and tooth trauma. It is important to us as dentists to remain vigilant as children depend on adults for protection. Hence, this review will culminate the investigations required by us not only as dentists but also as socially responsible adults.
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Affiliation(s)
- Preethi Murali
- Department of Oral Pathology and Microbiology, Meenakshi Academy of Higher Education and Research, Faculty of Dentistry, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
| | - Manoj Prabhakar
- Department of Oral Pathology and Microbiology, Meenakshi Academy of Higher Education and Research, Faculty of Dentistry, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India
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Vasseur P. [Identifying a child in danger during a consultation in the emergency department]. SOINS. PEDIATRIE, PUERICULTURE 2017; 38:37-42. [PMID: 28325386 DOI: 10.1016/j.spp.2017.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Child abuse is a public health issue. Many abused children present physical injuries which could be picked up in emergency departments. Caregivers must therefore be particularly vigilant from the moment the child arrives. Some reluctance to report potential abuse, notably due to denial or to being overly cautious can place the child in irreversible danger.
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Affiliation(s)
- Patricia Vasseur
- Urgences médico-judiciaires, Hôtel-Dieu, 1 place du parvis Notre-Dame, 75181 Paris cedex 4, France.
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Byard RW, Bellis M, Langlois NE. Vascular lesions simulating bruising. MEDICINE, SCIENCE, AND THE LAW 2016; 56:271-274. [PMID: 27614469 DOI: 10.1177/0025802416668770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Careful examination of the skin and soft tissues is a routine part of the forensic autopsy to identify and characterise traumatic lesions. Three cases are reported where benign vascular lesions presented as bruises. In case 1, a 44-year-old man with a history of epilepsy was found dead on the floor. Dissection of the neck revealed a haemorrhagic area 15 mm × 1.5 mm, deep to the left thyrohyoid muscle. In case 2, an 87-year-old man was found dead with a plastic bag over his head attached to an opened cylinder of nitrogen gas. On the mucosal surface of his upper lip, there was an apparent 5 mm blue/purple bruise. In case 3, examination of the back of a 16-month-old girl revealed an apparent 15 mm bruise. Histological examination of all three lesions revealed benign vascular lesions. In the absence of microscopy, these lesions would have been considered traumatic in origin, raising the possibility of inflicted trauma.
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Affiliation(s)
- Roger W Byard
- 1 School of Medicine, The University of Adelaide, Australia
- 2 Forensic Science SA, Australia
| | | | - Neil Ei Langlois
- 1 School of Medicine, The University of Adelaide, Australia
- 2 Forensic Science SA, Australia
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Langlois NEI, Olds K, Ross C, Byard RW. Heme oxygenase-1 and heme oxygenase-2 expression in bruises. Forensic Sci Med Pathol 2015; 11:482-7. [PMID: 25772118 DOI: 10.1007/s12024-015-9660-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 12/22/2022]
Abstract
The first step in catabolism of hemoglobin in a bruise is performed by the enzyme heme oxygenase, which produces biliverdin that is then reduced to bilirubin. The development of yellow coloration in bruises can be attributed to local accumulation of degradation products of hemoglobin, including bilirubin, but it is not clear why there is a delay before this color change is apparent. One explanation may be that time is required for the establishment of heme oxygenase activity at the bruise site. This study used immunohistochemistry to examine the time course of expression of heme oxygenase-1 and heme oxygenase-2 in a rat bruise model. Heme oxygenase-1 levels rose above background from 6 h to peak from days 1 to 3. There was strong expression by macrophages, but only occasional neutrophils expression of heme oxygenase-1. Heme oxygenase-2 did not change significantly from background levels. The results suggest that the delay in the development of yellow coloration of bruises may in part be attributed to the requirement for macrophages to be recruited to the site of injury.
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Affiliation(s)
- Neil E I Langlois
- Forensic Science SA, University of Adelaide, 21 Divett Place, Adelaide, SA, 5000, Australia. .,School of Health Sciences, The University of Adelaide, Adelaide, Australia.
| | - Kelly Olds
- School of Health Sciences, The University of Adelaide, Adelaide, Australia
| | - Claire Ross
- Department Anatomical Pathology, Queen Elizabeth Hospital, Adelaide, Adelaide, Australia
| | - Roger W Byard
- Forensic Science SA, University of Adelaide, 21 Divett Place, Adelaide, SA, 5000, Australia.,School of Health Sciences, The University of Adelaide, Adelaide, Australia
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Abtahi-Naeini B, Shapouri J, Masjedi M, Saffaei A, Pourazizi M. Unexplained facial scar: child abuse or ehlers-danlos syndrome? NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:595-8. [PMID: 25535610 PMCID: PMC4264297 DOI: 10.4103/1947-2714.145482] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Context: Child abuse is a serious problem, and its physical manifestations can be mimicked by certain diseases and conditions. These conditions can include genetic, congenital and other disorders that may result in poor weight gain, bone fractures or skin lesions that look like bruises or burns. Case Report: This paper reports the case of a seven-year-old girl with Ehlers-Danlos Syndrome (EDS), which was misdiagnosed as child abuse. This child was referred to us for treatment of an unexplained facial scar that was alleged to be the result of child abuse. Conclusion: When unusual skin presentations are observed, dermatologists should consider the possibility of child abuse to protect the child. Furthermore, they should be aware of the cutaneous abnormalities that mimic injuries associated with abuse to avoid the unnecessary reporting of child abuse.
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Affiliation(s)
- Bahareh Abtahi-Naeini
- Department of Dermatology, Medicine Students' Research Committee, Skin Diseases and Leishmaniasis Research Center, Isfahan, Iran
| | - Javad Shapouri
- Department of Pediatric, Qom University of Medical Science, Qom, Iran
| | - Mohsen Masjedi
- Department of Immunology, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Saffaei
- Pharmacy Students' Research Committee, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Pourazizi
- Students' Research Committee, Semnan University of Medical Sciences, Semnan, Iran
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Lecomte MMJ, Holmes T, Kay DP, Simons JL, Vintiner SK. The use of photographs to record variation in bruising response in humans. Forensic Sci Int 2013; 231:213-8. [PMID: 23890640 DOI: 10.1016/j.forsciint.2013.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/24/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022]
Abstract
There is considerable value in developing tools capable of accurately and reliably determining when bruises were inflicted in humans. Previous work has focused on the visual changes observed in a bruise as the injury develops and heals. However, due to variables such as how and where on the body the bruise was inflicted, differing tissue compositions at the injured skin site between individuals and inter- and intra-observer variation; a technique sufficiently robust for use in a clinical or medicolegal setting has not yet been identified. In this study we present a series of photographs taken under controlled conditions illustrating standardised bruises induced on participants using a weight dropping mechanism. We show that variation in the appearance of bruises over time across individuals is large and, although photography may be a suitable technique for the recording of injuries, it is not sufficiently reliable for determining the age of a bruise.
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Affiliation(s)
- Marie M J Lecomte
- The Institute of Environmental Science & Research Ltd (ESR) - Mt Albert Science Centre, Auckland, New Zealand.
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Non-accidental injuries found in necropsies of domestic cats: a review of 191 cases. J Feline Med Surg 2012; 14:723-8. [DOI: 10.1177/1098612x12451374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Animal cruelty is defined as a deliberate action that causes pain and suffering to an animal. In Brazil, legislation known as the Environmental Crimes Law states that cruelty toward all animal species is criminal in nature. From 644 domestic cats necropsied between January 1998 and December 2009, 191 (29.66%) presented lesions highly suggestive of animal cruelty. The main necroscopic finding was exogenous carbamate poisoning (75.39%) followed by blunt-force trauma (21.99%). Cats from 7 months to 2 years of age were the most affected (50.79%). In Brazil, violence is a public health problem and there is a high prevalence of domestic violence. Therefore, even if laws provide for animal welfare and protection, animals are common targets for violent acts. Within a context of social violence, cruelty toward animals is an important parameter to be considered, and the non-accidental lesions that were found are evidence of malicious actions.
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