Pediatric Skin Dimples
Pediatric Skin Dimples
Overview
Cutaneous dimples are localized depressions in the skin caused by tethering of the skin to deeper structures. While some dimples are benign developmental variants, others can indicate underlying structural or neurological abnormalities.
Key Points
- Prevalence: Approximately 3-8% of children have sacral dimples
- Age of Presentation: Usually noted at birth or early infancy
- Gender Distribution: Equal in males and females
- Inheritance: Can be sporadic or inherited in an autosomal dominant pattern
Embryology
Skin dimples develop during embryological development due to:
- Abnormal separation of neuroectoderm from surface ectoderm
- Altered dermal-fascial connections
- Focal dermal hypoplasia
Clinical Features
Common Locations
- Sacral region (most common)
- Lateral lower back
- Chin
- Shoulders
- Facial dimples (cheeks)
Associated Findings
- Hair tufts
- Skin tags
- Hemangiomas
- Pigmentary changes
- Subcutaneous lipomas
Red Flags
- Location > 2.5 cm above anal verge
- Base not visualized
- Diameter > 5 mm
- Multiple dimples
- Associated cutaneous markers
Classification & Types
1. Sacral Dimples
- Simple/Benign
- Small (<5 mm)
- Located within gluteal cleft
- Base visible
- No associated markers
- Complex/Atypical
- Large (>5 mm)
- High location
- Deep with invisible base
- Multiple associated findings
2. Facial Dimples
- Bilateral cheek dimples (inherited trait)
- Unilateral dimples (may be associated with branchial arch anomalies)
- Chin dimples (inherited trait)
3. Other Types
- Shoulder dimples
- Sternal dimples
- Lateral back dimples
Diagnosis & Workup
Initial Evaluation
- Complete physical examination
- Neurological assessment
- Documentation of:
- Size and depth
- Location relative to anal verge
- Associated cutaneous findings
- Base visibility
Imaging Studies
- Ultrasound
- First-line imaging for suspicious dimples
- Can identify dermal sinus tracts
- Best performed before 6 months of age
- MRI
- Gold standard for suspected spinal dysraphism
- Indicated for high-risk features
- Evaluates entire spine
Differential Diagnosis
- Dermal sinus tracts
- Spinal dysraphism
- Tethered cord syndrome
- Caudal regression syndrome
- VACTERL association
Management
Simple Dimples
- Reassurance
- Regular monitoring during well-child visits
- No specific intervention required
Complex Dimples
- Referral to specialists:
- Pediatric neurosurgery
- Pediatric dermatology
- Pediatric spine surgery
- Surgical intervention if:
- Confirmed spinal dysraphism
- Dermal sinus tract
- Tethered cord
Follow-up Care
- Regular neurological assessment
- Monitoring for:
- Growth and development
- Neurological symptoms
- Urological function
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
