Localized hirsutism

associated with localized hypervascularity and low-grade inflammation

• 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).
  [102]
• 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]