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Accidental Burn by Intentional Laxative Use
Sabrina MacDuff1, Joanne Sun, Derek E Bell
1From the *University of Rochester Medical Center, Rochester, NY; †Integris Baptist Medical Center, Oklahoma City, OK; and ‡Department of Surgery, University of South Alabama Medical Center, Mobile, AL.
Insights
Laxative-induced dermatitis can mimic child abuse burn injuries. Physicians should consider this condition, especially in diapered children, as it presents differently from typical scald burns.
Area of Science:
- Pediatric Dermatology
- Toxicology
- Child Abuse Forensics
Background:
- Child abuse is a serious concern, with burn injuries often leading to suspicion.
- Accurate diagnosis is crucial to differentiate between intentional harm and accidental or iatrogenic causes.
Observation:
- A case of a 33-month-old girl with buttocks and perineum burns initially suspected as child abuse.
- The burns were found to be caused by excessive administration of laxatives for chronic constipation.
Findings:
- Laxative-induced dermatitis presents a distinct pattern that differs from characteristic child abuse burn injuries.
- Diaper use is identified as a risk factor for developing laxative-induced dermatitis.
- The severity of laxative-induced dermatitis does not correlate with the laxative dosage.
Implications:
- Healthcare providers must be aware of laxative-induced dermatitis to avoid misdiagnosis of child abuse.
- Educating parents on the risks associated with over-the-counter laxative use in children is essential.
- This highlights the importance of a thorough patient history in pediatric burn evaluations.
Objective:
The purpose of this study was to present a case report and review the relevant literature on laxative-induced dermatitis being mistaken for scald injury and child abuse.
Case:
A 33-month-old girl presented with partial thickness burn to the buttocks and perineum, which were suspected to be caused by child abuse. On further investigation, the parents had been administering large doses of laxatives to the child for chronic constipation.
Discussion:
Child abuse by burning has characteristic physical examination findings, which differ from the pattern of laxative-induced dermatitis that has been reported in the literature. Diapers appear to be a risk factor for laxative-induced dermatitis. Surprisingly, the dose of laxative does not correlate with the severity of the burn injury. All physicians must be aware of the possibility of laxative-induced dermatitis mimicking scald burn injury to the buttocks. Parents should be educated about the risk of administering over-the-counter laxatives to children.