Case 53

This 6-month-old baby had been left with a babysitter for an evening. When the parents returned, the sitter reported the baby had been very unsettled for the first half of the evening. The baby was asleep when the parents went in to check her and so they left her asleep. The next morning, the mother changed the baby’s nappy/diaper and discovered a rash over the baby’s buttocks (Image 53). She was concerned about the nature of the rash, especially as there was no previous history of skin problems.

What is the nature of the rash?

What is the most likely cause?

https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig53.jpg"/>

122The infant has three circular red lesions on the buttocks and one oval blistered lesion on the posterior left thigh.

The most likely cause of the lesions is burns from a cigarette. The lesions are circular and in an unusual position, have appeared suddenly for a nappy rash and are unlikely to be staphylococcal. The round blistered lesions are typical of stubbing burns as they are round. The oval blistered lesion is typical of a brushing burn from a cigarette. Accidental cigarette burns are usually on exposed surfaces and many are brushing flame-shaped burns. Intentional non-scald burns are relatively common and are often associated with other non-accidental injuries such as bruises. Contact burns are the most common non-scald intentional burns, especially from household items such as cigarettes, irons, cigarette lighters, hairdryers and curling tongs. They are usually clearly demarcated in shapes that mirror the causative object and usually occur in children older than 3 years of age. They are often on the backs of hands, limbs or trunk. However, accidental burns may be significant markers of child abuse as it has been reported that a child who suffers an accidental burn is seven times more likely to suffer future abuse or neglect. ¹