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Screen Sacral Salmon Spots
Half of the newborns with occult spinal dysraphism have a cutaneous clue: lumbosacral midline skin abnormalities, including localized hypertrichosis, hemangioma, lipoma, dimple, and sinus tract. Nevus flammeus simplex (NFS) is another midline birthmark that has less often been associated with occult spinal dysraphism. This common vascular anomaly occurs in more than 40 percent of newborns, usually on the glabella and nape of the neck. Physicians from the Sackler School of Medicine in Tel Aviv prospectively examined all 3623 neonates born at their center during a 6-month period and found 28 (0.77 percent) with a sacral nevus flammeus simplex (SNFS) overlying the lumbosacral area.
Eighteen of the 28 (64 percent) also had NFS lesions in a cranial distribution. Females outnumbered males 2.5 to 1. In all, 25 of the 28 neonates (89 percent) had screening lumbosacral ultrasound One (3.6 percent) had diastematomyelia, which occurs in 0.04 percent of the general population. The authors conclude that SNFS is associated with occult spinal dysraphism and recommend a screening ultrasound for all neonates with this skin lesion.
Comment: Although the authors state that the infant with diastematomyelia had no other suggestive clinical signs, they fail to describe the configuration of the caudal nevus flammeus or to indicate whether cranial lesions were also present, information that might serve as more specific clues. Early diagnosis and treatment of occult spinal dysraphism are associated with improved neurologic outcome. Ultrasound is an efficient screening tool in newborns up to 6 months old, but it is inadequate for older infants and children. Children with SNFS or other suggestive midline caudal skin lesions who were not examined by ultrasound as infants should be screened by careful neurologic examination, and their caregivers should receive guidance regarding the early signs of occult spinal dysraphism: failure to achieve continence, persistent thigh pain, or lower-extremity weakness.
Published in Journal Watch Dermatology January 30, 2001
Citation(s):
Ben-Amitai D et al. Sacral nevus flammeus simplex: The role of imaging. Pediatr Dermatol 2000 Nov 17 469-471.
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