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Sacral Hair

Many newborns, especially those with increased skin pigmentation, will have an increased amount of hair over the lower back and sacrum. This appearance is entirely within normal limits and is not a marker for underlying spinal dysraphism.

photo by Janelle Aby, MD

Sacral Dimple

Sacral dimples are a commonly encountered finding on the physical exam. Most of these dimples are "simple dimples" and require no further evaluation. A simple dimple is one that is located within 2.5 cm of the anus, has a base that can be visualized and is not associated with other abnormalities on exam. The dimple in this photo is the tiny dark brown shadow below the slate grey patch at the superior end of the gluteal crease.

photo by Janelle Aby, MD

Sacral Dimple

Whe the skin lateral to the dimple is stretched, skin can be seen covering the entire dimpled area. If the base could not be seen, this would be called a coccygeal pit. Although fistulas above the gluteal cleft may be associated with spinal dysraphism, coccygeal pits are benign and do not need imaging.

photo by Janelle Aby, MD

Sacral Skin Tag

Skin tags in the sacral area are also potential indicators of spinal dysraphism. In some cases, the "tag" may in actuality be a residual tail. This skin tag was quite small and appeared to be very superficial, but spinal ultrasound was still done as a screening measure. In this case, the ultrasound was normal and no further testing was needed.

photo by Janelle Aby, MD

Butterfly Mark

Congenital midline vascular lesions usually raise questions about occult spinal dysraphism, but so far the literature is inconclusive. Some authors suggest isolated midline port wine stains and medial telangiectatic vascular nevi ("butterfly marks") are benign and do not require further evaluation. Occult dysraphism is much more likely if two markers are present, so this appearance in combination with another finding should lead to imaging. As an isolated finding, the need for evaluation is debatable.

photo by Janelle Aby, MD

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Sacral Hair

Sacral Dimple

Sacral Dimple

Sacral Skin Tag

Butterfly Mark

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