Cutaneous Signs of Dysraphism

Aka: Cutaneous Signs of Dysraphism, Cutaneous Signs of Spinal Dysraphism, Spinal Meningocele Dermatologic Findings, Skin Markers of Spinal Dysraphism

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II. Epidemiology

  1. Dermatologic signs seen in 50-90% of Spinal Dysraphism
  2. Skin findings may be only signs of occult lesion

III. Findings

  1. High Risk Findings (Lumbosacral MRI is preferred imaging modality)
    1. Midline Lipoma
    2. Dermal sinus
      1. Appears as large midline dimple above gluteal crease
      2. Do not probe dimple
  2. Moderate risk findings (Lumbosacral MRI or Ultrasound)
    1. Aplasia Cutis Congenita
    2. Atypical sacral dimple
    3. Gluteal furrow is deviated to one side
  3. Low risk findings (1 present: Consider Ultrasound; 2 present is a high risk finding)
    1. Hypertrichosis
    2. Midline Hemangioma (e.g. sacral Hemangioma)
    3. Mongolian Spot
    4. Nevus Simplex
    5. Port wine stain
    6. Small sacral dimple (normal if within gluteal crease or simple as described below)

IV. Findings: Sacral Dimple

  1. Simple sacral dimples do not require additional evaluation
    1. Shallow sacral dimple <0.5 cm in diameter AND
    2. Within 2.5 cm from anal verge
    3. And no hairy patches or Hemangiomas
  2. Further evaluate sacral dimples that do not meet these criteria or other midline defects
    1. Atypical dimples >5 mm or >25 mm from anal verge
    2. Deep or multiple dimples
    3. Dimples superior to gluteal crease, or offset from midline

V. Imaging

  1. Lumbosacral Ultrasound for Spinal Dysraphism
    1. Indicated in moderate risk findings in age <3 months (see above)
    2. Perform by 3 months of age (Vertebral body ossification in older infants obscures the Ultrasound)
    3. Typical, but is controversial, as it may not change management
  2. Spinal MRI
    1. Indicated in high risk findings or infants age >3 months
    2. Consider pediatric neurosurgery Consultation prior to imaging
    3. MRI in infants requires sedation

VI. Evaluation

  1. See Spinal Dysraphism

VII. References

  1. Chem (2012) J Neurosurg Pediatr 9(3): 274-9 [PubMed]
  2. Drolet (2004) Dermatol Clin 16(3): 447-53 [PubMed]
  3. Guggisberg (2004) Arch Dermatol 140(9):1109-15 [PubMed]
  4. Snyder (2024) Am Fam Physician 109(3): 212-6 [PubMed]

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