Aplasia cutis congenita

Fatal superior sagittal sinus hemorrhage as a complication of aplasia cutis congenita: a case report and literature review

Aplasia cutis congenita (ACC) is a rare condition that occurs in around 0.01% of births. Characterized by a localized absence of skin, it affects the midline of the scalp in over 80% of cases. We describe the case of an infant born via vaginal spontaneous delivery with ACC affecting the scalp. This extended to the subcutaneous tissue and bone leaving the dura mater exposed. The patient was managed conservatively. At 4 weeks of age, she had a fatal superior sagittal sinus hemorrhage. In a review of the literature, we found ten previous cases of hemorrhage of the superior sagittal sinus complicating an ACC. Including our case, ACC complicated by hemorrhage of the superior sagittal sinus shows a 36% mortality (4/11). An analysis of these cases suggests that this tends to occur between 1 and 3 months of age, though it may occur in younger neonates.

Bullous aplasia cutis congenita: case report and review of the literature

Aplasia cutis congenita is a rare condition characterized by the absence of skin and sometimes other underlying structures such as bone or dura. It can be a part of various syndromes and can be associated with multiple genetic diseases, malformation patterns, or a combination of all. It is even considered as a form frustre of a neural tube defect in several literatures. Bullous aplasia cutis congenita is a clinical subtype of the condition, with extremely few cases reported in the literature. It presents as a cystic or bullous lesion at birth, which eventually transforms into an atrophic, flat scar covered by a thin epithelium. Some cases present with a dark collar hair sign around the lesion, which can be even more indicative of an underlying neural tube defect. Management remains controversial and depends on the characteristics of the lesion, but conservative treatment is usually chosen.

Aplasia cutis congenita. A case of scalp defect repair using two opposing bipedicled local flaps

Aplasia cutis congenita is a rare congenital condition characterised by the absence of some or all layers of the skin. It may also be associated with absence of underlying muscle and bone. Where dura is exposed there exists a risk of ulceration and haemorrhage and thus primary closure is indicated. We report a case of cutis aplasia successfully closed with opposing bipedicled flaps. To our knowledge this is a novel approach which offers a simple safe technique that can be applied in the neonate.

A rare case of aplasia cutis congenita with refractory seizures

Aplasia cutis congenita is a heterogeneous disorder involving symmetric focal absence of skin at birth. A 1-year-old boy presented with the clinical manifestation of intractable complex partial seizures and development delay; physical examination revealed two fibrotic scars and alopecia. His parents were suspicious that the lesions were caused by birth trauma. The dermatologic diagnosis of aplasia cutis congenita was established, and cranial magnetic resonance imaging revealed a bony defect. Initially, the seizures were refractory and responded poorly to phenobarbital. Treatment with oxcarbazepine, levetiracetam, and clobazam achieved significant control. Although the presentation of aplasia cutis congenita with seizures is unusual, aplasia cutis congenita should, based on the present case, be considered as at least in part a neurocutaneous disorder.

Familial nonmembranous aplasia cutis of the scalp

Aplasia cutis of the scalp is often a sporadic condition, but familial occurrences with an autosomal dominant inheritance have been documented. Aplasia cutis of the scalp may be seen in two main clinical variants: oval-shaped membranous aplasia cutis and irregular, larger defects. We report six families in whom more than one member has aplasia cutis of the scalp, all of them with large irregular defects located over the vertex or anterior to the vertex along the sagittal suture. We review previous reports of this entity with clinical pictures and note that in most instances, the defects are of the nonmembranous variant.

Congenital Scalp and Calvarial Deficiencies: Principles for Classification and Surgical Management

Congenital defects of the scalp and skull present a challenge for care providers because of a combination of their rarity and the magnitude of potential morbidity. Recent advancements in autogenous and alloplastic cranioplasty and scalp reconstruction techniques argue for a comprehensive consideration of this problem. This article (1) reviews the causes of congenital scalp and calvarial defects; (2) proposes a classification system based on defect type, similar to the tumor-node-metastasis classification, in that defect location, defect size, and extent of neuromeningeal involvement are the critical variables; and (3) presents algorithms for care based on the defect classification. A set of management principles on which treatment plans can be based for these unique problems is provided.

Aplasia cutis cerebri with partial acrania--total reconstruction in a severe case and review of the literature

BACKGROUND

Aplasia cutis cerebri with partial acrania is a rare anomaly that can involve the epidermis, dermis, and subcutaneous tissues of the scalp with significant bone defect.

METHODS

The authors present the first successful report of providing one-stage complete cover in a case of aplasia cutis cerebri with major skull defect by using local rotational flaps. Also presented is a review of literature.

RESULTS

The newborn had a receding forehead and a large scalp defect from frontal to occipital bone measuring 10 x 8 cm2 involving full thickness of cranium centrally, thereby exposing the dura. Local rotation flaps were raised from the scalp to cover the 10- x 8-cm2 defect. The edges of the defect were showing granulation tissue with ingrowth of epithelium. Partial-thickness skin grafts were used to cover the raw area left at the nape of the neck after raising the rotation flaps. The child was discharged on the 19th postoperative day.

CONCLUSIONS

Aplasia cutis cerebri with partial acrania, as in our case, has a high mortality rate secondary to infection or to hemorrhage from ulceration of the sagittal sinus. The successful outcome of our one-stage local rotational scalp flap technique provided complete cover to this major scalp defect. This technique will definitely improve the management of this complex disorder keeping the morbidity to the minimum.

Bilateral abdominal aplasia cutis congenita associated with atrial septal defect: a case report

A full-term infant girl who had bilateral, symmetrical, sharply defined, triangular-shaped ulcers on both sides of the umbilicus is described. A punch biopsy specimen showed histologic findings of aplasia cutis. Echocardiographic examination revealed primum-type atrial septal defect. To our knowledge, this association is the first of its kind to be reported in the literature.

Aplasia cutis congenita and associated disorders: an update

We present an update of disorders in which aplasia cutis congenita is a feature. Localization of the lesion, important other features, and possible etiology are tabulated. Disorders are classified as chromosomal, monogenic, teratological/exogenous, and unknown. Points of particular interest in history taking and examination of patients with aplasia cutis congenita are presented.

Congenital cardiac malformations in Adams-Oliver syndrome

Two patients with Adams-Oliver syndrome and congenital cardiac malformations are described. A literature review revealed at 13.4% occurrence of congenital cardiac malformations in individuals with Adams-Oliver syndrome, suggesting that cardiac anomalies are a frequent manifestation of this syndrome. All patients with Adams-Oliver syndrome (aplasia cutis congenita and terminal digital anomalies) should be evaluated for cardiac anomalies.

Aplasia cutis congenita with epibulbar dermoids: further evidence for syndromic identity of the ocular ectodermal syndrome

We have investigated 2 young South African girls with aplasia cutis congenita, epibulbar dermoids, and strabismus. This unique association of anomalies was first documented in two unrelated boys by Toriello et al. [1993: Am. J. Med. Genet. 45:764-766]. Our clinical and histological findings are markedly similar, and we think this to be the second report of individuals with this rare syndrome.

Aplasia cutis congenita of the scalp in an infant exposed to valproic acid in utero

We report a newborn with isolated aplasia cutis congenita of the scalp whose mother was treated with valproic acid during pregnancy. Aplasia cutis congenita has been described in infants exposed in utero to antithyroid drugs, but has not been related to other tetratogenic agents. Fetal exposure to valproic acid is known to increase the risks of spina bifida and other midline defects. Interestingly, aplasia cutis congenita of the scalp is regarded as a cutaneous marker for neural dysraphism. However, this defect of the scalp and valproic acid intake during pregnancy may be a random association and similar observations are needed to suggest causality.

The history and contributions of the Spanish dermatosurgical school

The origin of dermatologic surgery in Spain may be traced to the efforts of Professor Felipe de Dulanto, Initially the specialty encompassed only simple direct closure, local flaps, and skin grafts. As the field evolved, distant flaps and other techniques, including dermabrasion, cryosurgery, Mohs' surgery, and laser surgery, were added to the armamentarium. The close, interdepartmental relationships between Dermatology and Otolaryngology, Ophthalmology, Pediatrics, and Gynecology allowed Spanish dermatologic surgery to expand and encompass lymph node dissections, complex reconstructions of the neck, eyelid, vulvar area, breasts, and abdomen.

Aplasia cutis congenita presenting as a familial triad of atrophic alopecia, ocular defects and a peculiar scarring tendency of the skin

We report two siblings with atrophic alopecia, ocular defects and an abnormal tendency to cutaneous scarring. To our knowledge this appears to be the first report of this familial oculocutaneous association and of this peculiar cutaneous scarring.