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Correspondence |

Native American Skin Offerings Mistaken for Acne Scars in a College Undergraduate

Allison Truong, BS; Jillian W. Wong, BA; Anne Lynn S. Chang, MD
Arch Dermatol. 2012;148(10):1214-1215. doi:10.1001/archdermatol.2012.592.
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Skin-offering rituals are a common component of the Sun Dance, an often secret annual religious ceremony practiced by Native Americans of the Great Plains and first recorded by Western observers over 150 years ago.1 Skin offerings symbolize personal sacrifice as part of a prayer for the welfare of one's family or community and are obtained by using wooden sticks to pierce the chest, back, or arm skin of either men or women (Figure 1). The sticks are connected to a ceremonial tree, and as the individual leans backward, small pieces of skin are rapidly torn off to become the skin offerings.1 We report a case of symmetric coin-shaped scars over the upper arms, chest, and back initially misidentified as acne scars in a college undergraduate student with severe acne vulgaris that was treated with oral isotretinoin.

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Figure 1.The Piercing, oil on canvas, artist unknown, circa 1862. Image has been reproduced in Sundancing: The Great Sioux Piercing Ritual1 and is reprinted here from that source with permission of the Tri S Foundation, Skiatook, Oklahoma.

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Figure 2. Scars from Native American skin offering ritual. A, Two coin-shaped scars with adjacent smaller scars over each breast due to skin offerings; central chest lesions are acne scars without any preceding external trauma. B and C, Respective close-up images of the chest scars pictured in panel A (indicated by arrows). D, Two coin-shaped scars over each scapula due to skin offerings. E, Linear array of 4-mm circular scars from skin offerings on the upper arm. All pictured measuring devices are calibrated in centimeters.




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