In most cases it is a simple completely benign skin feature and no therapies of any kind are needed. However, in some circumstances, the presence of a sacral dimple can undermine an anomaly to be borne by the spinal cord
Lucia has been born for a few hours and already fills her parents with joy. In the hospital room, where she and her mother recover the energies after the labors of the birth, the neonatologist carefully evaluates the little girl and then explains to the parents that Lucia is fine, but … «He has one sacral dimpleneeds further insights before you can go home ». And here is a veil of fear in their eyes. What does the doctor mean? What are the possible Problems related to a sacral dimple?
What is the sacral dimple?
What is the sacral dimple? Also called “sacro-coccigeo dimple”, is one Cute depression Present from birth and localized at the bottom of the back, in the lumbar or sacred region. Sometimes it can present itself with two small holes between the buttocks. It is distinguished in “typical”, when its size is lower than 5 mm in diameter And it is located less than 2.5 cm from the anus, and “atypical” when it exceeds these measures.
Is there to worry? In most cases it is a simple completely benign skin feature. No diagnostic insights are needed nor therapies of any kind and limits itself only to an irrelevant “aesthetic” fact. However, in some circumstances, it can undermine an anomaly on the spinal cordthe component of the nervous system that starts along the spine up to the lumbar region. This is therefore why the presence of a sacral dimple can require in -depth analysis.
When does the sacral dimple be closed?
Before talking about the Closing of the sacral dimple It is necessary to take a step back … the origin of the sacral dimple is still unclear: it is formed in the uterus, but the mechanisms through which this happens are not entirely known. Probably, during the early stages of embryo development (period in which the tagthat is, the layer that separates the internal environment from the external one of our body) can occur Closing defectswhich at birth will manifest themselves as the depressions of the skin. Genetic, environmental factors (such as pressure exerted in the phases of intrauterine development On the various organs) and still others unknown intervene in determining the formation of the dimple.
More understood is the process in which defects in the development of the fat tissue are associated with Malformations against the nervous systemfor the close proximity of the embryonic tissues from which they originate and for the stages that see them involved in the first six weeks of life. In the initial phases, in fact, central nervous system and spinal cord share the same tissue of origin with the skin (theectoderma). Over a few days, Actoderm cells are divided to form skin and nervous system. This process, which takes the name of “disjunction“, May undergo alterations on a genetic or often not known, determining a possible communication between the two organs along the middle line of the body, which goes From the head to the lower back.
Therefore, skin lesions can be the light of associated neurological malformations and, when present in the lumbosacral region, to suspect Spinal cord defects and of the vertebral column Not traceable in pregnancy, called “hidden spinal disaramphisms”. (1).
There Neurosurgical correction Of the defects of the spinal cord provides for the closure of the skin anomalies, such as the sacral dimple in the rare cases in which this is associated with an underlying neurological pathology.
Therefore, to summarize, When does the sacral dimple be closed? Never spontaneously and in most cases it does not require any type of intervention, with the exception of the simultaneous presence of spinal disarafisms that provide for a neurosurgical correction.
When to worry about the sacral dimple
THE Risks of the sacral dimple they increase when it is atypical (i.e., as mentioned, larger than 5 mm and located over 2.5 cm above the anus) and/or associated with other skin anomalies, such as:
- presence of a tuft of hair;
- emangiomaor dense collection of capillaries that forms a superficial or deep red lump;
- skin fold between the deviated buttocks;
- lipoma, or accumulation of fat in the subcute;
- dermal breastor skin demonstration similar to a very narrow small “tunnel”, which puts the body’s surface with the deepest regions in communication, up to the spinal cord.
The risk is greater if there is the associated presence of multiple skin anomalies. THE Problems of the sacral dimple They are therefore bound to the presence or absence of an underlying neurological pathology and not known at the time of birth. The largely important defects against the nervous system are subject to screening during pregnancy, through the Evaluation of the alpha-maternal fetoprotein (sample that is carried out between the 14th and 16th week of gestation), fetal ultrasound monitoring and the search for alpha-fetoprotein in amniotic liquid.
Furthermore, the intake at least a month before the conception of Folic acid -based supplements On the part of the future mother allows you to prevent the same conditions, in particular the most serious forms. However, the minor anomalies They can escape checks in pregnancy and, if not known at the time of birth or recognized, can become evident with the growth of the child. In particular:
- delayed acquisition of the control of the sphincters;
- delay in walking;
- development of deformity at the feet;
- Recurring meningitis and/or acute neurological symptoms in case of rapid growth malformations.
At birth, in some cases, it is precisely the skin events to allow early diagnosis. In particular, for the typical and isolated sacral dimples, recent studies define only clinical observation, and the execution of a magnetic resonance imaging Only if orthopedic or neurological signs appeared.
In the case of atypical dimples or deviations of the fold between the buttocksor in the case of an association of no more than two skin signs already described, the ultrasound assessment of the lumbosacral region is proposed and subsequently a magnetic resonance imaging if anomalies were highlighted.
Finally, in the presence of injuries considered to High risk of association with hidden spinal disarafisms (dermal breast, lipoma and appendix, or association of over two skin markets) The execution of a resonance is directly proposed.
Little Lucia, with an atypical and isolated sacred dimple, is assessed as ultrasound before the hospital. THE’absence of anomalies At the expense of the spinal cord allows doctors to reassure parents, explaining to them how the dimples along the back is a benign feature, quite common in infants, but which does not require further interventions. It will be important though pay attention to its cleaning To avoid the risk of any skin skin infections in the delicate diaper area. In the case of redness, presence of foul -smelling material or pus near the dimple, it is important to ask the pediatrician for advice on how to cleanse the little girl and possibly intervene.
