{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T03:47:58Z","timestamp":1762660078529,"version":"3.40.5"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Dermatology"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recognizable skin findings of child physical abuse include bruises, abrasions, lacerations, bite marks, burns, and oral injuries. Self\u2010induced skin picking, or neurotic excoriation, can correspond to emotional stress, underlying psychiatric illness, or substance abuse. Parental neurotic excoriation injury of children has not been reported previously as a form of physical abuse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We present a case series of five children abused via parental excoriation. All affected children were three years of age or younger and otherwise healthy. Each child presented with wounds determined to be consistent with chronic picking. Patient age, injury location, and in some cases, witness accounts confirmed the lesions were not self\u2010inflicted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In three cases, caregivers reported methamphetamine use. In these cases, caregivers repeatedly picked or wiped the infants\u2019 skin. In two cases, the caregiver demonstrated personal neurotic excoriation behavior, which was imposed upon her children resulting in similar lesions. One affected child died at 14\u00a0days of age from abusive head trauma, while the other four children were placed in foster care by Child Protective Services.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Excoriation injury places children at risk for significant scarring and other long\u2010term effects. We report examples demonstrating that repetitive skin injury by caregivers is a diagnostic consideration for abuse in young children.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pde.14623","type":"journal-article","created":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T21:30:10Z","timestamp":1622583010000},"page":"859-863","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Parental neurotic excoriation injury of children: A case series of hidden physical abuse"],"prefix":"10.1111","volume":"38","author":[{"given":"Larissa","family":"Hines","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Oklahoma Health Sciences Center at OU Health Oklahoma City Ok USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2761-8065","authenticated-orcid":false,"given":"Margaret E.","family":"Lang","sequence":"additional","affiliation":[{"name":"Mayo Clinic Alix School of Medicine Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie L.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tagrid M.","family":"Ruiz\u2010Maldonado","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Utah Salt Lake City UT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken W.","family":"Feldman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1626-0408","authenticated-orcid":false,"given":"Arne H.","family":"Graff","sequence":"additional","affiliation":[{"name":"Department of Family Medicine Mayo Clinic Rochester MN USA"},{"name":"Department of Pediatric and Adolescent Medicine Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5321-493X","authenticated-orcid":false,"given":"Jennifer L.","family":"Hand","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Adolescent Medicine Mayo Clinic Rochester MN USA"},{"name":"Department of Dermatology Mayo Clinic Rochester MN USA"},{"name":"Department of Clinical Genomics Mayo Clinic Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6]]},"reference":[{"issue":"10","key":"e_1_2_7_2_1","first-page":"669","article-title":"Diagnosis and management of physical abuse in children","volume":"88","author":"Kodner C","year":"2013","journal-title":"Am Fam 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