Abuse and Factitious Disorders

Recognizing the cutaneous manifestations of child abuse, including physical and sexual abuse, is an important component of the medical evaluation in both the hospital-based and outpatient setting. Subtle clues on the skin examination may indicate the need for further evaluation, and the provider needs to be able to distinguish the features of injuries suspicious for non-accidental trauma from accidental skin injuries, medical conditions such as vasculitis, and skin signs of cultural practices such as cupping. Clinicians should also be able to recognize the signs of child neglect, in particular in high-risk situations or in cases where child abuse is also suspected. With regard to anogenital skin findings, sexual abuse should be considered when the lesions present indicate trauma. Finally, the possibility of self-induced skin lesions should always be considered when the history and/or examination is not consistent with a defined skin disorder.