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What’s The Diagnosis 22

Child Skin Lesion

A six year old child is brought to the emergency department by an aunt and a Child Protective Services worker. He was sent home from school by the teacher who said that the child appeared to have marks from being hit over the shoulder by a whip. The school principal called Child Protective Services. The child says he wasn’t hit by a whip but can’t say what, if anything, did happen.

The lesion is dry, rough, and non-tender. It does not appear to be a bruise. No drainage. No fever. No URI symptoms. No other lesions anywhere else on the body. The child is up to date on immunizations.

What’s the diagnosis and what’s the treatment?

Answer posted below in a few days.

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 Answer: Lighter Burn to the NeckLighter Burn to the Neck with Comparison

The mark wasn’t caused by a whip, but rather was caused by a worse form of abuse.

A lighter burn is caused by keeping the flame of the lighter lit until the metal head of the lighter gets hot, then using the hot metal head to burn the skin.

See the picture for a comparison – probably not the same lighter, but the characteristic “U” -shaped outline of the lighter burn becomes more apparent. While the burn may initially appear too narrow to match the outline of the lighter head, by holding down on the patient’s shoulder and stretching the skin, a near-perfect match to the head of the lighter was obtained.

The patient and his sibling were removed from the household until further investigations could be completed.

21 comments

  1. Not a Doctor, no credentials or certifications, aside from a marriage license and three birth-certificates where my name appears.

    “Dx.” Over-loaded school back pack.

  2. Or something similar.

  3. Why did the school have the child’s clothes off?

  4. Does it bother anyone that a teacher would know what a whip mark looks like?

    FWIW, I’m seconding the backpack mark, since it looks exactly like what I had on my shoulders in my military days of marches, rucksacks, and sore feet.

  5. Question: Who paid for the ED visit?
    Question: What do the child’s CumCard entries say about this episode?

    • Question: Who paid for the ED visit?
      You and I did. If uninsured, the patients and family would have paid. School has no responsibility for payment regardless of the conditions put on demands for medical care.

      Question: What do the child’s CumCard entries say about this episode?
      I don’t even want to know what a CumCard is.

      • Back in about the Pleistocene, when I was an inmate of the public school system in and around Los Angeles (California), every inmate had a CummCard* (probably an abbreviation for something like Cumulative Record Card**, a yellow card that was The Permanent Record showing every Significant Event in your life).

        It was a powerful deterrent to misbehavior–the phrase “this WILL appear in your Permanent Record” (or a variant “I WILL be making an entry in your cummcard”) striking fear in the soul of a young miscreant.

        *I may have misspelled it earlier, or maybe not–I don’t think the sexual term “cum” had been invented yet–it certainly was not in wide circulation.

        **I don’t know anybody (including my mother, a School Secretary) that called it anything other than (phonetically) cume card.

  6. Good guesses – especially with the start of school – but this is more localized and smaller than you’d see with a backpack mark. Note the ruler in the picture – the area is only about an inch at largest width. Also, it is rough in texture. A bruise from a backpack would be smooth.

  7. Port wine stain?

  8. if NAT: lighter burn
    if innocent, I still think lighter but just boys being boys and playing with fire

  9. Hmmm. It could be a bite mark but there is no “bottom” and if it were broken skin, it would be much more ugly. I thought of yeast, but it’s too red…a clothing “burn” or a self induced scratch from an itch is my guess.
    Nice to see you back, WC!

  10. I was inclined towards the backpack injury myself, since I suffered from similar lesions in my firefighter days due to the self-contained breathing apparatus (SCBA) we wore. But those marks rended to appear on my clavicles.

    Just from appearance, though (and without interviewing the child) I’d have a hard time calling these whip marks.

  11. I’m wondering if that is a healing second-degree burn, dunno what from.

  12. Well, I’m probably way off base here considering that we are talking about a 6yr old, not a 12 yr old, but my first thought was a hickey.

  13. This disturbs me……

    Does this child have a history of abuse?

    Active boys imo always has bruises especially if they are a rough tumble type like my 4 year old.

    Dr WC care to clarify?

    • “Does this child have a history of abuse?”

      Well, yeah–the teachers take his clothes off of him for SOME reason.

      • OMG

        Say this phrase out loud and REALLY think about it.

        “the teacher take his clothes off………”

        If a teacher ever I mean EVER undressed MY child so God help me he/she would be in the ER.

        This is where I find this so disturbing. Is this teacher a pediphile? Has he/she behaved inappropriately with her/his students???

        I guess you are ok with that but I am not. Their are proper procedures to follow. Were the police called once the marks were discovered??

    • There was no history of abuse … until this was reported.

      I wasn’t as concerned about the teacher noticing the burn. Given the location of the lesion, if a child is wearing a tank top or a shirt with a loose collar, it wouldn’t be that hard to see at least part of it.

      And I have to give a shoutout to the teacher for catching this. It is sometimes frustrating when children are forced to see the doctor for menial things before they are allowed to return to school. Just yesterday, a child came to the ED after being sent home from school for a cough and not allowed to return until she was “not contagious.” She had been out for three days and then the school called the mother and threatened truancy charges unless the child returned or had a doctor’s note.
      In this case, though, the doctor’s visit probably saved two siblings from many more years of abuse.

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