What are the cutaneous signs of child abuse?

Because child abuse can lead to acute morbidity and mortality, its recognition should be of paramount importance when evaluating pediatric patients. Cutaneous signs of abuse include:

• Bruising and abrasions: These lesions are usually present in patterns or in areas not consistent with the history or trauma from common childhood accidents (Fig. 64-7).
• Burns with unusual patterns: Some examples are cigarette burns that appear randomly over the body or dunking scald injuries, which have distinct borders and, occasionally, have a “doughnut” pattern around the buttock area when the buttock is pressed against the cooler tub surface.
• Generalized wastage and dermatitis: These are due to neglect and malnutrition.
• Traumatic alopecia: This alopecia demonstrates hemorrhage, irregular outlines, or hematoma formation.
• Bite marks of adults can be distinguished from a child’s by the width, which in adults is >4 cm. Mudd SS, Findlay JS: The cutaneous manifestations and common mimickers of physical child abuse, J Pediatr Health Care 18:123–129, 2004.