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  • Child abuse, elder abuse, and domestic violence are common and affect patients of all socioeconomic classes and races.

  • Identifying specific cutaneous findings concerning for physical abuse allows for early intervention to impact outcomes.

  • Bruising on soft padded areas of the body and patterned bruising that are multiple and in different stages of healing are suspicious of abuse.

  • Burns that are bilateral and uniform are suspicious of abuse.

  • Law mandates the reporting of all suspected cases of child abuse and, in some states, elder abuse.


Abuse is a world-wide medical issue that is notoriously difficult to diagnose in those who are either not able to provide reliable histories (especially seen in pediatric, geriatric, or cognitively impaired patients) or those who fear the ramifications of reporting abuse (pertinent to any victim of abuse).

The main diagnostic challenge lies in the various manifestations of physical abuse due to great diversity of patients and range of means used to inflict trauma. Injuries can result from primary trauma (abrasions, hematomas, choke marks) or secondary effects of an initial trauma (such as in thermal injuries). Superficial cutaneous signs can also indicate the presence and extent of internal injury. Both severe penetrating and blunt trauma can cause bone fractures, torn ligaments, and joint instability. Internal organ hemorrhage can produce fatal consequences and are especially of concern in (though not exclusive to) head and abdominal injuries. Identifying specific cutaneous findings concerning for physical abuse may allow for early intervention to impact outcomes.


Types of abuse and their respective incidence rates are listed in Table 102-1. More than 1 type of abuse can occur simultaneously.9,10

Table 102-1Types of Elder Abuse


Despite potentially severe morbid and even fatal consequences, child abuse remains under-identified and thus under-reported.1,2 In the United States, child abuse/neglect annual incidence is 700,000 to 1.25 million children, with approximately 18% of cases involving physical abuse.3-5 Among the United States and developed countries of Europe, the prevalence of physical abuse anytime throughout childhood ranges from 5% to 16%, with only 5% of all episodes estimated to be reported to child protective services.6,7 It is estimated that more than 300,000 children suffer from sexual abuse each year in the United States. The lifetime risk of sexual abuse is approximately 25% to 40% for girls and approximately 10% for males.


Elder abuse is one of the fastest-growing forms of abuse. Although statistics vary, the National Center ...

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