Injuries to the [[Human skin|skin]] are amongst the most common indicators that a child is being [[Physical abuse|physically abused]]. These injuries may be in the form of [[burn]]s and [[bruise]]s; those which are intentionally inflicted often have characteristic locations, patterns and shapes that can help differentiate them from accidental injury. The ability to recognize these types of inflicted injuries as well as the various [[Differential diagnosis|differential diagnoses]] - medical conditions which may mimic some of the cutaneous signs of abuse - is a key element in child protection.<ref>Swerdlin A, Berkowitz C, Craft N. Cutaneous signs of child abuse. J Am Acad Dermatol. 2007 Sep;57(3):371-92. PMID 17707148</ref>
==Bruises==
===Location===
*Accidental bruises tend to occur on the ankles, shins, hips, lower arms, elbows and under the chin.
*Inflicted bruises are often found on the upper arms, buttocks, face, neck and ears. Bruising to the soft tissue areas of the cheek, abdomen, upper thighs and genitalia are highly suggestive of abuse.<ref>Enid Gilbert-Barness, Diane E. Debich-Spice: Handbook of Pediatric Autopsy Pathology. p.483 Humana Press; (2004) ISBN 158829224X</ref>
===Types===
*'''Tramline bruise''': two linear shaped bruses separated by a linear area of relatively unbruised skin, which results from being struck with a rectangular or cylindrical object.<ref>Danielson L., Rasmussen O V. Dermatological Findings After Alleged Torture. pp.109-112 [http://www.irct.org/Files/Filer/TortureJournal/16_2_2006/4_dermatological_findings.pdf]</ref><ref>Krishnan Vij: Textbook Of Forensic Medicine And Toxicology: Principles And Practice. p.287 (Elsevier India) (2011) ISBN 9788131226841</ref>
*'''Linear bruising''' the slap of an open hand may leave parallel linear bruises on the cheek or elsewhere, brusies may also be caused by objects such as a stick, rod etc.<ref>Child Abuse and Neglect: Guidelines for Identification, Assessment, and Case Management. editors: Marilyn Strachan Peterson, Michael Durfee, Kevin Coulter; p. 26 Volcano Press (2003) ISBN 1884244211</ref>
*'''Pinch mark''': two oval shaped bruises, with one bruise - caused by the thumb - larger than the other, separated by an area of relatively unbruised skin. Depending upon the amount of pressure applied a [[hematoma]] may be present within the area between the two bruises. Curvilinear lacerations caused by the fingernails may be present in one or both of the two bruised areas, typically these occur in smaller pinch marks where the skin is pinched between the fingernails.<ref>U.K. Department of Health: [http://www.cpdt.org.uk/tab02/2_4_1_0.htm Child Protection and the Dental Team]</ref>
*'''Fingertip bruising''' caused by grabbing or squeezing the flesh appear as oval shaped bruises with the bruise caused by the thumb some distance away. Not all of the fingers may leave a bruise as a result of uneven pressure being applied.<ref>American Academy of Pediatrics, American College of Emergency Physician: The Pediatric Emergency Medicine Resource p.328; Jones and Bartlett Publishers; 4 edition (2006) ISBN 076374414X</ref>
==References==
<references/>
==External links==
*[[University of Chicago]]: Cutaneous Manifestations of Child Abuse[http://pediatrics.uchicago.edu/chiefs/documents/cutaneous_injuries_REECE.pdf]
[[Category:Child abuse|:]]
[[Category:Medical diagnosis]]
[[Category:Dermatology]]
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