A chemical burn simulating child abuse

Several forms of child abuse exist, including physical and emotional abuse and neglect, and sexual abuse. Cutaneous injuries are common and the classical cutaneous signs of child abuse are well known. Most physicians, however, are unaware of the unusual practices utilized for potential therapeutic effect by various ethnic groups which may result in traumatic skin lesions simulating those of child abuse. Two folk treatments which cause lesions that may be interpreted as the cutaneous manifestation of child abuse are Cao gio (Vietnamese coin rubbing) and cupping (an eastern European practice). We recently had the opportunity to care for a child who presented with circumferential second- and third- degree burns of the ankle and foot. The initial suspicion was child abuse. Further investigation revealed that the lesion was caused by treatment of a sprained foot with a remedy based on the hot-cold theory of disease commonly practiced in many Latin American cultures.