Sacred Skin Involvement And How It Affects Children

Some babies have a sacral skin retraction, which is “a smile hole”, in the lower back, also known as the sacral area. The sacrum is a bone located in this area.

The sacral skin retraction can be a simple pit that does not cause any discomfort. However, this indentation is sometimes associated with the spinal canal and can cause problems in the nervous system.

Today’s article will describe this in more detail and also discuss the treatment.

What is a sacral skin retraction?

As mentioned above, a sacral skin retraction is a notch or depression that appears in the lower back. It is present from birth. The recess is usually located just above the buttocks.

Most pits of this type are harmless. However, a significant percentage is associated with spina bifida. This refers to certain congenital anomalies that cause incomplete closure of certain structures, such as the spine.

It is a heterogeneous group of malformations that expose neural tissues. The same study says that between 40 and 95% of babies with spina bifida have some kind of skin disorder. There is a sacred skin involvement in many of these cases.

Above all, assume that the sacral skin retraction is severe if it is near a hair accumulation or there are color changes in the skin immediately near it. The problem is that there may be neurological, rectal, orthopedic or urinary tract problems in these cases due to neural change. That is why it is important to be able to single them out and seek treatment for it.

Types of sacral skin retraction

A sacral skin retraction can be typical or atypical. It is this simple distinction that makes it possible to see the difference between a benign case and something serious. A typical or simple sacral skin retraction is small and lies in the crack between the buttocks.

These are usually less than 5 mm in diameter and are located near the edge of the anus. They are quite frequent and involve no risk of hernia. Estimates actually indicate that almost 5% of healthy newborns have them.

In contrast, there are atypical pits that are larger, over 6.5 mm deep and further away from the anus. They can actually be located close to the sides.

An atypical pit is a risk factor for spina bifida. In fact, there may be abnormal communication with the spinal cord when they are too deep. The spinal cord is a sensitive structure that many nerve fibers pass through.

Thus, this communication can lead to spinal and neurological damage. Also this type hudinndragning may be accompanied by changes in skin color, lumps, and it can even be areas with unusual hair growth.

The difference between a sacral skin involvement and a pilonidal cyst (twin)

A pilonidal cyst contains hair formations inside. As with sacral skin retraction, it occurs in the intergluteal area, just above the buttocks.

What happens in pilonidal desire is that hair, cells, waste products and fluid accumulate, resulting in a collection. In addition, it usually develops after birth, it is more common in men and is often infected. The result is severe pain and swelling.

Causes of sacral skin retractions

The causes of sacral skin involvement have not yet been identified, but we know it is congenital. This makes it possible to distinguish it from a pilonidal cyst, as we mentioned above.

Atypical skin retractions may be derived from this defect in the closure of the midline structures. However, we do not know why this is happening.

Symptoms and diagnosis

In general, a sacral skin retraction is asymptomatic. This is because it is just a pit, a cutaneous change in the lower back.

However, atypical sacral skin withdrawals usually have symptoms that depend on whether it is due to spina bifida. A doctor must do a thorough physical examination to detect it.

They usually measure and check the properties of the dimension and must perform a series of complementary tests if it is too large or deep. The same applies if there are several skin incisions, if there is discoloration of the skin, or if it is too far from the anus.

According to a study published in the Archives of Disease in Childhood , ultrasound is a method of studying skin contractions. Estimates indicate a sixfold increase in the likelihood of a back problem when abnormalities are present.

Ultrasound is a preferred technique because it is fast, safe and inexpensive. However, there is always the possibility of an MRI if there is doubt about the diagnosis. This is because it is a more precise examination of the tissues.

Possible complications

Atypical pits have several complications and may be related to spina bifida or tethered spinal cord, among other conditions.

Spina bifida is a congenital malformation. What happens is that the neural tube does not close properly. There are different types, but the one that is related to the sacral skin retraction is s pina bifida occulta .

The main characteristic is a small gap in the spine that appears because the spine has not developed. It can be asymptomatic and is usually detected in adolescence or adulthood.

In contrast, tethered spinal cord occurs when it is scar tissue that anchors the spinal cord. It can lead to urinary and fecal incontinence, weakness in the lower extremities and even difficulty standing.

Treatment of sacral skin retractions

There is no treatment for a simple sacral skin retraction, and there is no need for it. All you have to do is prevent dirt from accumulating in the area to prevent infections. This is because the skin retraction is too close to the anus and intestinal bacteria can contaminate it.

This is why it is important to clean this area of ​​the baby properly, especially when changing diapers. An atypical pit may require treatment, depending on the severity.

The procedure depends on the stage of sacral skin involvement

Ideally , all newborns should be thoroughly examined by a doctor, and these should do a study of the sacral skin involvement if they find one. It consists of measuring the depression together with other abnormalities.

The child should be in good health if everything else is normal and the skin involvement is small. However, the baby will require a specialist if the pit is atypical or there are other danger signs.

Physicians must examine a pit carefully to determine if there are any neurological changes or developmental defects. The best treatment for a given case must also be considered depending on specific results.

Finally, remember that most sacral skin withdrawals are harmless and only a skin change. However, you must consult a doctor and rule out a neurological problem.