Title : A literature review of the correlation between faun tail nevus presentation and spinal dysmorphisms

Background: Faun tail nevus (FTN) is a rare congenital cutaneous finding characterized by a localized tuft of hair over the lower lumbar vertebrae, typically in a midline distribution. Although faun tail nevus can be present without underlying spinal abnormality, it is frequently seen in the presence of underlying occult spinal dysraphism, most commonly spina bifida occulta. The purpose of this piece is to bring attention to its potentially underrecognized clinical significance in dermatologic practice.

Objective: To highlight the association between faun tail nevus and spina bifida occulta and to emphasize the role of dermatologists in early identification and referral.

Methods: A review of published case reports, case series, and dermatology literature describing faun tail nevus presentation was performed. An emphasis was placed on associated spinal imaging findings, neurologic presentation, and management. Severity of faun tail nevus presentation was compared with extent of abnormal MRI findings. Findings were analyzed to assess the correlation between FTN and occult spinal anomalies, with specific interest to the severity of the nevus as compared to severity of dysraphism in the same child.

Results: Faun tail nevus typically presents at birth or early childhood as a distinct patch of hair localized to the lumbosacral region. Review of the literature demonstrates a strong association between FTN and underlying spinal dysraphism, most commonly spina bifida occulta, tethered cord, and diastematomyelia. It is of importance to underline the fact that many affected patients are neurologically asymptomatic at presentation. The underlying spinal abnormalities were typically only discovered after dermatologic recognition prompted imaging.

Although rare cases of isolated FTN without spinal involvement have been reported, the majority of documented cases reveal underlying abnormalities on magnetic resonance imaging. The ability of asymptomatic patients to obtain MRI scans after dermatologic recommendation varied on socioeconomic factors, highlighting the difficulties underserved populations face in the pursuit of preventative care. Notably, many patients lack neurologic or urologic symptoms at presentation, underscoring the importance of visual recognition rather than symptom-driven evaluation. In the absence of such symptoms, many patients may be dissuaded from perceived unnecessary screening.

Conclusion: Faun tail nevus is a clinically significant dermatologic marker of spina bifida occulta and other forms of occult spinal dysraphism. Dermatologists should maintain a low threshold for spinal imaging when FTN is identified, even in asymptomatic patients, to facilitate early diagnosis and multidisciplinary management.

FTN represents a high-risk cutaneous marker of occult spinal dysraphism. Early identification by dermatologists and prompt spinal MRI can prevent delayed diagnosis and potential neurologic sequelae. Recognition of FTN should trigger collaboration with neurology and neurosurgery prior to cosmetic management.

To be updated shortly..