Key Points
- Basis forensic knowledge helps dermatologists
- Recognizing signs of physical abuse
- Bioterrorism
San Francisco — Not every dermatologist will see symptoms of bioterror attacks or be called upon to help police solve murders. But 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, Brooklyn,
N.Y., and director of clinical research at SUNY Downstate in Brooklyn, N.Y. She is also in private practice at South Nassau
Dermatology in Oceanside, N.Y.
Abuse
During the past year, Dr. Lowenstein has examined four cases of suspected abuse. 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. Similarly, the patient's husband said her own smoking in bed caused a series
of burns on her chest.
"But nobody drops their ashes in an even circle. I could tell that somebody had put out cigarettes on her chest," Dr. Lowenstein
says.
When Dr. Lowenstein checked with her local adult protective services, "There were files open on this patient for abuse in
two other boroughs. So you have to have a level of suspicion."
In another case, a mother's explanation that her child suddenly developed a painful foot rash rang false because the child's
clearly demarcated wounds were signs of 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," Dr. Lowenstein says.
Bioterrorism
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 on the skin and in the lungs. 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.
Since Sept. 11, 2001, many more people worry about smallpox being used as a weapon. After the Twin Towers attack, "Most dermatologists
got a lot more consults where patients had chickenpox but were worried about smallpox, because these entities are not so easy
to tell apart," Dr. Lowenstein says.
Disclosures: Dr. Lowenstein reports no relevant financial interests.
Practice Tools
