Dermatoses misdiagnosed as deliberate injuries

Abstract

Examination of non-accidental injuries on a body should be done with caution, as often skin diseases can mimic deliberate injuries. Patients with active dermatoses or their residual/post-inflammatory spots seen during autopsy can generate false alarms or suspicion of burns, child abuse or battering, sexual assault or other medicolegal cases. The inability to distinguish between a mechanical injury and skin disease can cause unnecessary anxiety and can complicate medicolegal investigations. Many times, an elaborate history to find out the aetiology of the lesion is either unavailable or not reliable as in the cases of young children, insane or mentally subnormal patients or in medicolegal deaths. The greatest chance of misinterpretation may be in cases of extensive denudation of the skin seen in severe drug reactions like toxic epidermal necrolysis, which can be mistaken for scald burns. Other important cases include bruises diagnosed on seeing discoloured spots on the skin or genital lesions raising the suspicion of sexual abuse in children. This diagnostic dilemma can also lead to undue forensic investigations, imprecise expert opinions and distress to patients or their family members. This review aims to generate awareness about proper interpretation of findings with an open mind, the clues to differentiate between true and false injuries and the management thereof.