In this issue of the Archives, Levine et al1 describe the situation of a 3-year-old girl with lesions on her vulva, removed from her parents' care on suspicion of sexual abuse diagnosed by both a pediatrician and a gynecologist. Only after a dermatologist performed a biopsy 11 months later and diagnosed the lesions as localized vulvar pemphigoid was custody returned to the parents.
This case is not a bizarre aberration. Indeed, the footnotes to the article by Levine et al1 indicate many instances in which skin conditions have simulated child abuse, including sexual abuse.
Publicity surrounding child abuse in recent years has created a concern, even a hysteria, about the harm being done to children. But there is another side to the problem that rarely receives much public attention—the injustices and injuries inflicted on children and families caught up in the child protection system.2
Other examples abound:
The New York Times Magazine (September 15, 1991:52) reported the story of a New Jersey family
Vorenberg E. Diagnosing Child AbuseThe Cost of Getting It Wrong. Arch Dermatol. 1992;128(6):844-845. doi:10.1001/archderm.1992.01680160128020