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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.