Developing Guidelines for Differentiating Non-Accidental Trauma from Chronic Skin Conditions through the Intersection of Pediatric Dermatology and Child Protective Services

¹Department of Medicine, Baptist Health, Birmingham, AL, USA

²Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, NY, USA

³Department of Medicine, St. Joseph’s Hospital BayCare, Tampa, FL, USA

⁴Department of Medicine, Lakeland Regional Health, Lakeland, FL, USA

⁵Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA

⁶Department of Dermatology, Northwell Health, New Hyde Park, NY, USA

*Corresponding author: Kelly Frasier, DO, MS, Department of Dermatology, Northwell Health, New Hyde Park, NY, USA, Phone: 3105956882, Email: [email protected]

Received Date: July 14, 2025

Publication Date: August 30, 2025

Citation: Gray BA, et al. (2025). Developing Guidelines for Differentiating Non-Accidental Trauma from Chronic Skin Conditions through the Intersection of Pediatric Dermatology and Child Protective Services. Dermis. 5(4):45.

Copyright: Gray BA, et al. © (2025).

ABSTRACT

Accurately distinguishing non-accidental trauma (NAT) from chronic dermatologic conditions in pediatric patients remains a challenge requiring an interdisciplinary approach. Many skin disorders—including phytophotodermatitis, coagulopathies, atopic dermatitis, epidermolysis bullosa (EB), vasculitis/vasculopathy, and genetic skin fragility disorders—can present with bruise-like lesions, burns, erosions, or excoriations, closely resembling signs of inflicted injury. The absence of standardized dermatologic criteria in forensic evaluations increases the risk of both misdiagnosis and unnecessary child protective interventions, particularly in children with skin of color, where post-inflammatory pigmentary changes and resolving dermatoses can be misinterpreted as abuse-related trauma. Establishing evidence-based guidelines to differentiate dermatologic mimickers from inflicted injuries requires a structured approach incorporating pattern recognition, lesion morphology, anatomical distribution, and adjunctive diagnostic testing. Key distinguishing features include the presence of koebnerization, symmetric versus asymmetric lesion distribution, the timing of lesion evolution (synchronous vs. asynchronous healing), histopathologic correlates, and associated systemic findings. Advanced diagnostic tools such as dermoscopy, polarized light examination, and targeted laboratory and genetic testing can provide additional clarity in ambiguous cases. Strengthening collaboration between pediatric dermatologists, forensic specialists, social workers, and child protection teams have the potential to refine forensic assessments and ensure accurate evaluations that balance patient welfare with parental rights. Implementing standardized dermatologic evaluation protocols within child protective services has the potential to reduce misdiagnosis, minimize unnecessary family separation, and ensure that true cases of maltreatment receive appropriate intervention. Integrating dermatologic expertise into forensic frameworks allows for a more precise and equitable approach to evaluating pediatric cutaneous findings.

Keywords: Pediatric Dermatologists, Skin Tones, Forensic Investigations, Allergic, Pediatric Patients