Contours of Justice: Unveiling Forensic Dermatology in India

Forensic dermatology implies providing dermatological expertise to aid criminal investigations where skin-related evidence is prevalent. Being prominent and easily identifiable, skin findings play a pivotal role in forensic examinations. Clinical forensic dermatology analyzes skin, hair, and nails to discern injury patterns indicative of violent incidents. This discipline aids in identifying instances of abuse, neglect, assault, and torture within clinical settings.[1]

Dermatologists can play a crucial role in distinguishing mimickers of sexual abuse from genuine cases, such as lichen sclerosis. It is essential to correlate the wounds with the provided history because not every genital injury can be attributed to abuse.[2,3] Concerns about abuse may arise due to the presence of contusions. Still, other possible mimickers, like drug-induced pigmentation or other cutaneous manifestations of systemic illness, must be excluded before giving an opinion.[4,5,6] Certain conditions, like osteogenesis imperfecta or Ehlers-Danlos syndrome, can mimic signs of physical abuse, necessitating a thorough examination and clinical history for an accurate diagnosis. Scars from injuries due to torture may lack typical features, requiring thorough examination. Additionally, dermatopathology can provide vital evidence, particularly in electrical injuries and wound age estimation, which are crucial in criminal investigations. Thus, dermatological findings can provide critical evidence in legal contexts, aiding in the identification and documentation of abuse or torture cases and ultimately helping in the administration of justice.

Needless to say, nail and hair examinations are essential in forensic investigations, offering valuable insights into a crime. Nail clippings can potentially contain DNA from perpetrators, while nail abnormalities like Mees’ lines can indicate heavy metal poisoning.[7,8] Hair analysis, through both macroscopic and microscopic examination, helps determine its origin, exposure to substances like dyes or toxins, the method of removal, and indications of drug abuse.[9,10] Hence, this trace evidence plays a vital role in forensic dermatology, aiding in identifying perpetrators, unraveling the circumstances surrounding a crime, and providing justice to survivors of crimes.

Currently, India’s dermatology training curriculum emphasizes clinical management with limited attention to medicolegal implications. This oversight presents a significant gap in preparing future experts to recognize signs of abuse, torture, self-inflicted injuries, and factitious disorders, particularly in cases involving children, potentially compromising patient safety and impeding the delivery of justice. Even if they recognize the signs of abuse, they often lack knowledge about the reporting process and the legal implications. While accurate diagnosis and management of medicolegal cases are manageable in a tertiary care centre, where collaboration between dermatologists and forensic experts is possible, this responsibility can be overwhelming for individual practitioners. Thus, integrating forensic dermatology into the curriculum is crucial to enable them to manage such cases effectively, as evidenced by Jelousi et al.[11]

Currently, to the best of our knowledge, the documentation of forensic findings and evidence in clinical dermatology practice in India lacks standardization, with no national guidelines explicitly addressing the process. However, existing general guidelines for recording findings could serve as a foundation.[12,13] Furthermore, customizing existing national sexual assault guidelines to suit the needs of the dermatology community could standardize practice across the country.[14,15] Practitioners should also familiarize themselves with existing national guidelines for managing survivors of sexual violence and similar protocols, as outlined by Pande et al., which explain the workflow and emphasize a holistic approach. This would further prepare dermatologists to navigate the medicolegal complexities in clinical practice.[16,17]

Professional dermatological associations/societies could embark on creating a task force to develop national guidelines for documenting findings and handling evidence, which could serve as reference documents for all dermatologists in India. This could include a checklist, workflow, and standard operating procedures (SOP), as well as standardized forms for recording dermatological findings in cases with medicolegal implications, ensuring thorough and uniform documentation. Such a system would enhance the evidentiary value of these records in court and support dermatologists when serving as expert witnesses. Understanding these can improve care delivery, enable practitioners to make sound medicolegal decisions, and ensure that dermatological evidence is effectively utilized in legal proceedings, ultimately strengthening the justice process and safeguarding the interests of both patients and practitioners.

Moving forward, it is imperative to foster interdisciplinary collaboration and research initiatives focusing on various aspects of forensic dermatology, particularly in child abuse cases. Practicing dermatologists must be equipped with a deep understanding of the legal obligations surrounding the reporting of abuse and ensuring the safety and well-being of vulnerable individuals. Increased awareness among dermatologists regarding the legal implications of their practice is essential, as ignorance may not serve as a valid defence in a court of law. By promoting interdisciplinary dialogue and education, we can empower dermatologists to play a proactive role, enhance knowledge exchange, and promote best practices.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.