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The Best of the Best
Aug 2012

Top-Accessed Article: Skin Markers of Occult Spinal Dysraphism in Children

Arch Dermatol. 2012;148(8):934. doi:10.1001/archdermatol.2012.728

Guggisberg D, Hadj-Rabia S, Viney C, et al. Skin markers of occult spinal dysraphism in children: a review of 54 cases. Arch Dermatol. 2004;140(9):1109-1115.

“Marker” skin lesions on the posterior midline are evident in approximately 80% of individuals with occult spinal dysraphism.1 In a retrospective study of 54 children with congenital midline lumbosacral skin lesions, Guggisberg and colleagues found that 61% (11 of 18) of patients with 2 or more types of cutaneous findings in this location had occult spinal dysraphism compared with 8% (3 of 36) of those with a single skin finding (P < .001). Although small numbers of patients precluded risk assessment for specific types of isolated lumbosacral skin lesions, the authors concluded that certain solitary lesions (eg, a lipoma or a dermal sinus) were “high risk.” More recently, a prospective study showed an approximately 35% risk of spinal anomalies in patients with an isolated lumbosacral infantile hemangioma larger than 2.5 cm in diameter,2 adding this to the high-risk category. Both Guggisberg and coauthors and Drolet et al2 emphasized the need for spinal magnetic resonance imaging in individuals with multiple or high-risk isolated lumbosacral skin lesions, noting only approximately 50% sensitivity for spinal ultrasonography (even if performed at <4-6 months of age).

From October 2010 to August 2011, this article was viewed 2916 times on the Archives of Dermatology Web site.

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Contact Dr Schaffer at the Department of Dermatology, New York University School of Medicine, 560 First Ave, Rm H-100, New York, NY 10016 (julie.schaffer@nyumc.org).

References
1.
Schropp C, Sörensen N, Collmann H, Krauss J. Cutaneous lesions in occult spinal dysraphism—correlation with intraspinal findings.  Childs Nerv Syst. 2006;22(2):125-131PubMedArticle
2.
Drolet BA, Chamlin SL, Garzon MC,  et al.  Prospective study of spinal anomalies in children with infantile hemangiomas of the lumbosacral skin.  J Pediatr. 2010;157(5):789-794PubMedArticle
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