From the Guidelines
A tuft of hair in the sacral crease of a baby is usually normal and not a cause for concern. This finding, sometimes called a sacral dimple with hair, is common in newborns and infants. In most cases, it represents a normal variant of development and doesn't require any treatment or intervention 1. However, if the tuft of hair is accompanied by other signs like a deep dimple, skin discoloration, swelling, or fluid drainage, it would be worth mentioning to your pediatrician at your next visit. These additional findings might occasionally indicate a connection between the skin surface and the spinal canal (called spina bifida occulta or other neural tube defects) 1.
Key Considerations
- The presence of a tuft of hair in the sacral crease can be associated with underlying spinal cord malformations, but this is not always the case 1.
- A good rule of thumb is that if one draws an imaginary line between the tops of the 2 forks of the gluteal cleft, a dimple at or below this line is normal, whereas a dimple located above this line is abnormal 1.
- Isolated coccygeal dimples do not require further workup or treatment, but other types of dimples or skin findings may require evaluation by a specialist 1.
Recommendations
- If the tuft of hair is isolated and not accompanied by other signs or symptoms, no further action is necessary.
- If the tuft of hair is accompanied by other signs or symptoms, or if there are concerns about the baby's development or health, it is recommended to consult with a pediatrician for further evaluation and guidance 1.
From the Research
Significance of Mild Tufted Hair in the Sacral Crease
- The presence of mild tufted hair in the sacral crease can be a normal finding, but it may also be associated with occult spinal dysraphism 2.
- A study found that cutaneous stigmata, including hairy patches, are not useful markers for predicting occult spinal dysraphism 2.
- However, another study suggested that certain types of lumbosacral skin findings, including subcutaneous lipomas and faun tail nevi, should prompt an imaging study, but simple coccygeal dimples do not need imaging 3.
- The management of asymptomatic newborns with lumbosacral skin findings, including mild tufted hair, is not universally agreed upon among pediatric neurosurgeons, with some recommending imaging and others recommending watchful waiting or routine care 3.
Diagnostic Approaches
- Ultrasound is considered a first-line imaging modality for evaluating spinal anomalies in newborns, due to its safety, minimal invasiveness, and cost-effectiveness 4.
- Spinal MRI is also a commonly recommended imaging modality, particularly for cases where ultrasound is inconclusive or where there are concerns about occult spinal dysraphism 3.
- The choice of imaging modality and the decision to perform imaging or subspecialty consultation depend on various factors, including the type and severity of the lumbosacral skin finding, as well as local referral patterns and availability of imaging services 5, 3.
Clinical Implications
- The presence of mild tufted hair in the sacral crease should be evaluated in the context of other clinical findings, including the presence of other cutaneous stigmata or congenital anomalies 6, 2.
- Pediatricians and neurosurgeons should be aware of the potential for occult spinal dysraphism in asymptomatic newborns with lumbosacral skin findings, and should consider imaging or subspecialty consultation on a case-by-case basis 3.
- Further research is needed to clarify the significance of mild tufted hair in the sacral crease and to develop evidence-based guidelines for the management of asymptomatic newborns with lumbosacral skin findings 5, 3.