Developing Guidelines for Differentiating Non-Accidental Trauma from Chronic Skin Conditions through the Intersection of Pediatric Dermatology and Child Protective Services

INTRODUCTION Distinguishing between pediatric dermatologic conditions and non-accidental trauma (NAT) is a critical yet complex task in clinical practice. Many chronic or genetic skin disorders, such as atopic dermatitis, epidermolysis bullosa, coagulopathies, and vasculitis/vasculopathy, can present with skin findings that closely resemble physical abuse, including bruising, burns, excoriations, and erosions. This is particularly significant given that the skin is the most common organ involved in cases of nonaccidental injury [1], with up to 90% of physically abused victims exhibiting cutaneous findings [2,3]. This clinical overlap poses a significant diagnostic dilemma for healthcare providers, particularly when dermatologic expertise is not integrated early into the initial evaluation process.