title: Severe Photo-oxidative Injury from Over-the-Counter Skin Moisturizer: A Child Abuse Mimic.
abstract: BACKGROUND
  The cutaneous manifestations of pathological conditions have been described to mirror findings commonly associated with child abuse. Although it is important for clinicians to report suspected abuse, vigilance is required to detect conditions that mimic abuse. Phytophotodermatitis, a phototoxic reaction to furocoumarin-containing plants, is a well-described mimicker of nonaccidental trauma. However, non-furocoumarin-containing chemicals may cause similar presentations through a process called auto-oxidation. Typically, these chemical reactions occur as a result of aero-oxidation or, less commonly, photo-oxidation.
  
  
  METHODS
  We report the first pediatric case of photo-oxidative contact dermatitis from an over-the-counter skin moisturizer. A 12-month-old Hispanic boy presented to the Emergency Department with an apparent scald burn over his anterior chest and left shoulder. Given the lack of apparent cause, a nonaccidental injury was suspected. He was admitted to the pediatric service under the consult of Dermatology and the child maltreatment team. Further history and clinical progression strongly suggested a photo-oxidation reaction from chemical components in a widely available over-the-counter skin moisturizer. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights an infrequently reported cause of pediatric contact dermatitis: a photo-oxidative reaction to chemical components in skin moisturizer. It is important for the clinician to be able to differentiate injuries secondary to nonaccidental trauma from conditions that mirror their presentation. The clinical features of this case mimicked child maltreatment and underscore the importance of an interdisciplinary team approach in the care of these children.
authors.affiliation: Department of Pediatric Dermatology, University of California at San Diego - Rady Children's Hospital, San Diego, California.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Krakowski
authors.affiliation: Department of Pediatric Emergency Medicine, University of California at San Diego - Rady Children's Hospital, San Diego, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Gutglass
authors.affiliation: Department of Pediatric Emergency Medicine, University of California at San Diego - Rady Children's Hospital, San Diego, California.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Auten
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D017484:Dermatitis, Phototoxic / Q000175:diagnosis*; D004643:Emollients / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D004643:Emollients
keywords: aero-oxidation; child abuse mimic; contact dermatitis; photo-oxidation; skin moisturizer