Case 1: & Case 2:
A 13-year-old girl of African American descent is brought to the pediatrician's office because
of a lesion on her neck. The girl's mother had telephoned the office before the visit, stating
that the lesion resembled a blister at first, but now looked like a burn.
In the office, the girl is afebrile and not distressed. She explains that she awoke the
morning prior to the visit with a blister on the right side of her neck. It gradually became
bigger, and she used cold washcloths to wipe it. The central area became more painful and
the skin layers peeled off, revealing a weepy, inflamed circular area (Figure 1). The burn
is of second degree in the center and first degree in the surrounding tissue. There are no
other skin findings, and the rest of the physical examination is normal.
The mother is very upset by the finding but can offer no explanation. The girl repeatedly
says she does not know how the lesion occurred.
An 11-year-old boy is brought by his mother to the pediatrician's
office with a 1-day history of a rash on his shoulders
and arms. His mother relates that he woke up with
the rash, and she was very concerned about how quickly
it appeared. The patient is a healthy boy who denies any
recent illness, associated pruritus, trauma to the skin, or
use of any new products.
Physical examination reveals macular, hyperpigmented
lesions on the boy's shoulders and upper arms. They
appear in a similar pattern on both shoulders without
vesiculation, petechiae, or bruising. The rest of the physical
examination is normal.
Because child abuse is suspected, photographs are
obtained (Figures 2 and 3). Note the linear hyperpigmented
marks in Figure 3.
Have the children in these 2 cases been intentionally
harmed-or is there a medical explanation in both
cases for the lesions?
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