Cutaneous Signs of Dysraphism

1. See Also
   1. Spinal Dysraphism
   2. Newborn Skin Exam
   3. Cutaneous Signs of Rheumatic Disease
2. Epidemiology
   1. Dermatologic signs seen in 50-90% of Spinal Dysraphism
   2. Skin findings may be only signs of occult lesion
3. 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)
4. 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. Ultrasound for Spinal Dysraphism by 3 months of age is typical but is controversial as it may not change management
      2. Chem (2012) J Neurosurg Pediatr 9(3): 274-9 [PubMed]
5. Evaluation
   1. See Spinal Dysraphism
6. References
   1. Drolet (2004) Dermatol Clin 16(3): 447-53 [PubMed]
   2. Guggisberg (2004) Arch Dermatol 140(9):1109-15 [PubMed]