Alternate Light Source Findings of Common Topical Products

Abstract

Background One of the important roles of a forensic clinician is to perform examinations of patients who are victims and suspects of crime. Alternate light source (ALS) is a tool that can improve evidence collection and enhance visualization of injuries. The purpose of this study was to examine if commonly used topical products fluoresce or absorb when examined with an ALS. Secondly, we aim to identify patient and exam variables that may impact findings. Methods A convenience sample of 81 subjects was used. Following the application of 14 over-the-counter products, researchers observed the participants’ skin with an ALS under 18 combinations of wavelengths and colored filters. Results Of the 14 products viewed (n=1458 observations per product), six were found to fluoresce under alternate light in more than 40% of observations, 5 fluoresced in 1–10% of observations and 3 fluoresced less than 1% of the time. One product (a make-up product) absorbed ALS light consistently (81%), a second (a sunscreen product) absorbed in 7%, while the remaining 12 products produced absorption findings in less than1% of observations. In generalized mixed linear models, absorption findings were more commonly identified in participants with light or medium skin tones when compared to those with dark skin tones. Discussion These results suggest the presence of topical products may impact ALS findings. A thorough forensic clinical assessment should include a documented history, including assessment of potential sources of findings to aid in interpretation.

Detection of Inflicted Bruises by Alternate Light: Results of a Randomized Controlled Trial

“…For example, we noted several instances of scars, tattoos, hyperpigmented areas, nevi, acne, and other lesions that demonstrated absorption under alternate light but distinguishable from bruising under direct white light assessment. In addition, washing the skin before ALS application, as we did, may remove topical products (i.e., cosmetics and sunscreen) known to cause light absorption (26,27). Performing follow-up assessments in clinical practice may also capture changes in absorption over time more consistent with a healing bruise.…”

“…The few available studies have found use of an ALS enhanced bruise observation, but researchers were unable to control for the potential effects of false positives either through study design (21,24,25) or execution (23). Confounding factors, such as preexisting skin conditions and topical products, could mimic bruising by producing absorption under alternate light (21,26,27). Additionally, none of the research to date has examined how skin color impacts detection of bruising using an ALS.…”

Improving the Forensic Documentation of Injuries Through Alternate Light: A Researcher–Practitioner Partnership

“…Evidence-based procedures for implementing ALS in forensic nursing practice will include conditions of use, application during skin assessments, patient and user safety considerations, documenting use and findings, photodocumentation, and maintenance and storage of the ALS equipment. Necessary clinical steps, considering the context of forensic nursing practice, such as cleansing the skin before ALS application but after sample collection (when applicable), will be included based on the available research evidence ( Anderson et al, 2020 ; Pollitt et al, 2016 ). The internal facilitators at both study sites will receive specific training in preparation for their role as “champions.” Champions serve as a readily available resource to staff and encourage the staff’s engagement in adopting and implementing practice changes when using the ALS tools.…”

“…Although ALS is one modality for completing a skin assessment, it is not a diagnostic tool for bruising. Specific skin lesions and topical products can mimic bruising when viewed under alternate light (e.g., hyperpigmentation, scars, tattoos, nevi, sunscreen, makeup; Holbrook & Jackson, 2013 ; Olds et al, 2017 ; Pollitt et al, 2016 ). Using ALS technology provides additional data for interpretation of findings within the context of the patient history, physical assessment, and follow-up examinations (when possible).…”

Didn't put a label on it: Examining intimate partner strangulation within a diagnostic framework

“…Using ALS, FNEs were often able to better visualize and document findings in five of the eight cases that were consistent with the women's recollections of their strangulations. Literature is emerging to highlight both the potential uses (Scafide et al, 2020) and current limitations (Pollitt et al, 2016) of ALS use in clinical practice. Although further investigation is warranted, the use of ALS (Scafide et al, 2020) shows promise and may provide additional support to guide subsequent diagnostic imaging and differentiation of higher risk patients.…”