Forensic dermatology

March 8, 2009

San Francisco - Dermatologists rarely see symptoms of bioterror attacks or help police solve murders, an expert says. Nevertheless, she says a working knowledge of forensics can help any dermatologist in daily practice.

San Francisco

- Dermatologists rarely see symptoms of bioterror attacks or help police solve murders, an expert says. Nevertheless, she says a working knowledge of forensics can help any dermatologist in daily practice.

"Every dermatologist does a certain amount of forensics detective work on live patients - if nothing else, looking at suspected cases of abuse, neglect or drug use," says Eve Lowenstein, M.D., Ph.D., chief of dermatology, Brookdale Hospital, and director of clinical research at SUNY Downstate in Brooklyn, New York. She is also in private practice at South Nassau Dermatology.

During the past year, Dr. Lowenstein has examined four cases of suspected abuse, she says. She also has used her sleuthing skills to diagnose and treat problems ranging from motor-vehicle accident wounds to self-inflicted skin cutting.

Although abuse can occur in any community, she says it is more prevalent in financially stressed populations, such as the one served by Brookdale Hospital.

In one particularly egregious case, Dr. Lowenstein says she examined a bed-bound, HIV-positive female with hand injuries originally diagnosed as evidence of an IV blowout. Dr. Lowenstein quickly recognized the wounds as immersion wounds caused when someone had put the patient’s hands into scalding liquid, or poured it over them.

In another case, she says a mother's explanation that her child suddenly developed a painful foot rash rang false, because the child’s clearly demarcated wounds indicated immersion in hot water.

"In cases like this, we must routinely do a series of x-rays looking all over the body. Sure enough, the child had a broken humerus and multiple other fractures of different ages."

Private dermatologic practices aren’t immune to mysterious or suspicious skin injuries, Dr. Lowenstein says.

"I’ve seen cases involving skin cutting in my private practice. This behavior is associated with suicidal risk and other problems such as obsessive-compulsive disorder," she says.

At the same time, dermatologists stand on the front lines of addressing many Centers for Disease Control and Prevention Class A bioterrorism threats. Anthrax, for example, can manifest itself in the lungs as well as on the skin. In 2001, a dermatologist diagnosed cutaneous anthrax in the child of a news reporter who had received an envelope containing anthrax spores through the mail, Dr. Lowenstein says.

Occasionally, dermatologists also handle what Dr. Lowenstein calls "the CSI stuff," or examining skin findings to assist in criminal investigations.

In such analyses, a working understanding of forensic terminology proves helpful, she says.

When it comes to injuries, for example, "There are differences between abrasions, contusions and lacerations. They are all forms of blunt-force trauma," as opposed to sharp-force wounds such as stabs or bites. With lacerations, she explains, bridging tissue remains across the wound, while this isn’t the case with sharp-force wounds.

"Often, one can tell what kind of weapon was used by the marks left behind," Dr. Lowenstein says. DT