Solving riddles: Knowledge of basic forensics helps derms in daily practice

Key Points

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

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.