Phytophotodermatitis mimicking child abuse

Barradell, R.; Addo, Ahmad; McDonagh, A.J.G.; Cork, Michael J.; Wales, J.

doi:10.1007/bf01956735

Cited by 16 publications

(12 citation statements)

References 5 publications

(4 reference statements)

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“…15 Such conditions include bleeding disorders16; connective tissue disorders10 15; dye, paint, and pen marks10; folk remedies17 18; phytophotodermatitis19; Mongolian blue spots14 15 20; and cafe au lait spots 10. Therefore, errors in diagnosis can occur14 and a mistaken diagnosis of abuse can be devastating for a family.…”

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confidence: 99%

The prevalence and distribution of bruising in babies

Carpenter¹

1999

Archives of Disease in Childhood

131

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Aim-To obtain a prevalence rate and determine the distribution of accidental bruising in babies. Methods-177 babies aged 6-12 months were examined naked to look for bruises. They were seen in health visitor hearing test clinics and child health surveillance clinics. The site, size, shape, and colour of bruises were recorded on a skin map, and the parent's explanation noted. Any other injury was recorded. Data collection included the baby's age, mobility and weight, demographic details, and health visitor concerns. Results-Twenty two babies had bruises, giving a prevalence rate of 12%. There was a total of 32 bruises, 15 babies had one bruise. All bruises were found on the front of the body and were located over bony prominences. Twenty five of the bruises were on the face and head, and seven were on the shin. The babies with bruises on the shin were mobile. There was a highly significant increase in bruises with increase in mobility. Conclusions-The study has produced a prevalence and distribution of bruising in babies and sets a baseline from which to work when assessing bruises. It also tested out the methodology, which could be used in further research, particularly of younger babies. Clinicians need to assess a baby's level of development when considering whether a bruise is accidental.

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confidence: 99%

The prevalence and distribution of bruising in babies

Carpenter¹

1999

Archives of Disease in Childhood

131

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“…11 Phytophotodermatitis is sometimes a difficult diagnosis 12 to the untrained eye, occasionally leading to the inappropriate investigation of child abuse. [13][14][15][16] If the adult touches a child after touching plants or fruits containing furocoumarins, the pigmentary changes may have a ''digitate'' appearance, which differ from healing bruises caused by child abuse. Bruises following injury change color from red to yellow over several days and do not show the characteristic brown postinflammatory color of plant dermatitis.…”

Section: Discussionmentioning

confidence: 99%

Phytophotodermatitis in 19 children admitted to hospital and their differential diagnoses: Child abuse and herpes simplex virus infection

Carlsen

Weismann²

2007

Journal of the American Academy of Dermatology

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“…Phytophotodermatitis simulating child abuse [1][2][3] has been reported in children due to the garden herb rue [3] and to the inadvertent application of lime juice [2].…”

Section: Discussionmentioning

confidence: 99%

Phytophotodermatitis mimicking non-accidental injury or self-harm

Mehta

Statham

2006

Eur J Pediatr

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A 12-year-old girl presented to the paediatric department at Singleton Hospital, UK, with an eight-day history of rash. The rash was located mainly on the exposed parts of the body, namely, her face, arm and shin. She had visited a bird sanctuary in sunny weather, the surrounding wetlands containing a wide range of vegetation. A day later, a rash appeared and was described as "red spots" and "bruiselike." More lesions continued to appear over the next three days. She was in good health and there was no past history of any skin problems. She was not on any medication. An initial diagnosis of non-accidental injury (NAI) or self-harm was made, which caused great distress and concern to the family. A second opinion was sought from a dermatologist.Investigations revealed normal full blood count, biochemistry and clotting profile.On examination, she had linear inflamed erythematous eruptions on her right forearm with some circular lesions ( Fig. 1). Similar lesions were present on the left shin. There was streaky macular hyperpigmentation on the right side of her chin (Fig. 2) and face. A diagnosis of phytophotodermatitis was made. Any further investigations for NAI were discontinued. DiscussionPhytophotodermatitis is a phototoxic inflammatory reaction that occurs when the photosensitiser "psoralen," contained in the sap of plants, comes in contact with skin, followed by exposure to UVA light with wavelength in the range 320-380 nm. This gives rise to erythema, vesicle and blister formation, followed by hyperpigmentation. Hyperpigmentation can also occur without obvious dermatitis. The linear streaky appearance of lesions (inflamed or hyperpigmented) is key to diagnosis. This pattern results from brushing of the plant's stem and leaves with the skin. Phytophotodermatitis is a self-limiting condition. Regular use of UVAblocking sunscreens in the spring and summer may help diminish the cutaneous effects of phytophotodermatitis.The treatment of this condition includes removal of the offending agent and symptom control. Topical steroids of mild to potent strength can be used, depending on the degree of inflammation, site of the lesions and the age of the child, alongside analgesics.Four main plant families implicated as the causative agent are Umbelliferae (hogweed, cow parsley, wild parsnip, celery, wild carrots), Rutaceae (rue bergamont, citrus fruits), Moraceae (figs) and Leguminosae (scurf pea) [4].Phytophotodermatitis simulating child abuse [1-3] has been reported in children due to the garden herb rue [3] and to the inadvertent application of lime juice [2].The combination of linear inflammation, blisters or vesicles and hyperpigmentation occurring on exposed skin after playing in the parkland or wetland during the summer Eur J Pediatr (2007) 166:751-752

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Phytophotodermatitis mimicking child abuse

Cited by 16 publications

References 5 publications

The prevalence and distribution of bruising in babies

The prevalence and distribution of bruising in babies

Phytophotodermatitis in 19 children admitted to hospital and their differential diagnoses: Child abuse and herpes simplex virus infection

Phytophotodermatitis mimicking non-accidental injury or self-harm

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