Author Affiliations: Department of Dermatology, Stanford University School of Medicine, Stanford, California (Ms Truong and Dr Chang); University of Utah School of Medicine, Salt Lake City, Utah (Ms Wong).
Skin-offering rituals are a common component of the Sun Dance, an often secret annual religious ceremony practiced by Native Americans of the Great Plains and first recorded by Western observers over 150 years ago.1 Skin offerings symbolize personal sacrifice as part of a prayer for the welfare of one's family or community and are obtained by using wooden sticks to pierce the chest, back, or arm skin of either men or women (Figure 1). The sticks are connected to a ceremonial tree, and as the individual leans backward, small pieces of skin are rapidly torn off to become the skin offerings.1 We report a case of symmetric coin-shaped scars over the upper arms, chest, and back initially misidentified as acne scars in a college undergraduate student with severe acne vulgaris that was treated with oral isotretinoin.
Truong A, Wong JW, Chang ALS. Native American Skin Offerings Mistaken for Acne Scars in a College Undergraduate. Arch Dermatol. 2012;148(10):1214-1215. doi:10.1001/archdermatol.2012.592