UMEM Educational Pearls

Title: What's the Diagnosis?

Posted: 11/7/2016 by Tu Carol Nguyen, DO
Click here to contact Tu Carol Nguyen, DO

Question

8 year-old female with no PMH who presents with concerns for "purple patches" popping up on her arm for 2-3 days. Stated that one appeared and then, the other one appeared 12 hours later. She denied any trauma whatsoever, history of easy bleeding/bruising and did feel safe at home. The rest of the review of systems was negative.

Patient said there was mild pain when the area was touched. The rest of the physical examination was normal.

What's the diagnosis? (Image below)

Answer

Superficial Thermal Burn

Upon further questioning, patient stated that she had been making s'mores by roasting marshmallows over an electric stove 3 days prior. The burns showed up the subsequent morning.

Thermal injury
- Types - scald, contact, fire, chemical, electrical, radiation
- Can still sustain dermal burns from emanating heat without contact
- Extent of tissue damage based on temperature & duration of exposure

Non-accidental burns are common in children
- 10% of physically abused children have intentional burns/scalds
- Sites: hand, back, wrist, buttock, feet, legs
- Type: well-define margins of contact/scald burns in unusual places, glove-and-stocking distribution

Take Home Points:

Take a good history
Can sustain burns without direct contact (i.e. heat, radiation, etc.)
Consider non-accidental burns in children

Previous pearls about burns:

Pediatric Burns:

References

Monseau AJ, Reed ZM, Langley KJ, Onks C. Sunburn, Thermal, and Chemical Injuries to the Skin. Prim Care. 2015;42(4):591-605.

"Pathophysiology of Thermal Injury." Civic Plus. 2007.