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Localized hirsutism
    Differential Diagnosis[Top] [Nav]
associated with localized hypervascularity and low-grade inflammation
    Discussion -- not available online[Top] [Nav]
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  • Mentions several cutaneous signs to seek on the lower back:
    • Lipomata may be a sign of spina bifida or of a dumbbell-shaped lipoma extending into the cauda equina via a bony defect.
    • A hairy patch, especially in conjunction with a lipoma, gives a reinforced indication of underlying bony pathology.
    • Birth marks or excessive port wine marks may also indicate spinal dysraphism.
    • Café-au-lait spots and neurofibromas are signs of neurofibromatosis.
    • A patchy reddened coloration may indicate either infection or the long-term use of a heating element, which results in mottling of the skin (see Mergener's paper, below).
  • The tuft of hair associated with spinal dysraphism has been called the "Faun's beard" because it bears some resemblance to the beard of the faun in Roman mythology. [103]
  • Tethered cord syndrome is caused by malascent of the conus medullaris. Symptoms may not appear until adulthood, however. Several clinical features may be encountered, including cutaneous stigmata of spinal dysraphism in 62%. [104]
  • Pictures, plus a nice one-page review. [105]
  • "A dusky discolouration of the skin over the epigastrum or lower thoracic spine -- erythema ab igne -- suggests that the patient has used a heat source for pain relief [of pancreatitis] over a long time." [109]
  • "Mongolian spots are frequently noted over sacral and other areas in the darker races and occasionally in the white-skinned races, and persist for a variable number of years after birth." [p. 181] [110]
    Footnotes in Print Edition[Top] [Nav]
    (1) Localized hirsutism after radical inguinal lymphadenectomy [letter].
  Finck SJ, Cochran AJ, et al.   N Engl J Med 1981 Oct 15;305(16):958.  Pubmed  Similars
    (2) Lumbosacral skin lesions as markers of occult spinal dysraphism.
  Hall DE, Udvarhelyi GB, et al.   JAMA 1981 Dec 4;246(22):2606-8.  Pubmed+Abstract  Similars
    New References[Top] [Nav]

Localized hirsutism
    101.New hair growth over fracture sites [letter].
  Ravin N.   N Engl J Med 1990 Aug 2;323(5):350.  Pubmed  Similars

Spinal dysraphism
    102.Physical Examination of the Spine and Extremities.
  Hoppenfeld S. Norwalk, CT: Appleton-Century-Crofts, 1976: 238.   Amazon.com
    103.Medicine, Literature & Eponyms: An Encyclopedia of Medical Eponyms Derived from Literary Characters.
  Rodin AE, Key JD. Malabar, FL: Robert E. Krieger, 1989: 76.   Amazon.com
    104.Tethered cord syndrome as cause of spinal cord dysfunction [letter].
  Kiechl S, Kronenberg MF, et al.   Lancet 1996 Aug 3;348(9023):342-3.  Pubmed  Similars
    105.Picture of the month. Occult spinal dysraphism.
  Waler JA, Tunnessen WW Jr.   Am J Dis Child 1992 Jul;146(7):835.  Pubmed  Similars
    106.Evolution and the human tail: a case report.
  Ledley FD.   N Engl J Med 1982 May 20;306(20):1212-5.  Pubmed  Similars
    107.Tale of a tail [letter].
  N Engl J Med 1982 Oct 21;307(17):1089-90.  Pubmed  Similars

Systemic disease and the lower back
    108.Hyperpigmentation of the skin along the thoracic and lumbar spine in progressive systemic sclerosis [letter; comment].
  Sukenik S, Buskila D, et al.   J Rheumatol 1991 Dec;18(12):1946-7.  Pubmed  Similars
    109.Chronic pancreatitis [see comments].
  Mergener K, Baillie J.   Lancet 1997 Nov 8;350(9088):1379-85.  Pubmed  Similars
    110.Pigmentation of the skin.
  Jeghers H.   N Engl J Med. 1944;231:88-100,122-136,181-189.
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:33 PDT on July 4, 2000.[Top]

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