Hypophosphatasia And Skin Dimples
Figure 1.63. Dimples in between the joints over the long bones are considered pathologic until proven otherwise. In this infant with congenital hypophosphatasia, the skin dimple over the middle of the tibia is a very typical finding. Abnormal (aberrant) skin dimples may occur at a location where there has been a closer than usual proximity between die skin and the underlying bone structure during fetal life, resulting in deficient development of subcutaneous tissue at that locus. Such dimples may be secondary either to a loss of subcutaneous tissue or to an aberrant bony promontory. These may also cause breakdown of the dermis widi ulcer formation.
Figure 1.64. An example of an abnormal skin dimple in an infant with camptomelic dysplasia. Note the extreme prenatal distortion of the bones with the development of the aberrant skin dimples over the abnormal bony prominences. The most common site for this type of abnormal skin dimple is over the apex of a severe curvature of the tibia in cases of fibular hypoplasia, but other areas can be similarly affected.
Figure 1.65. This infant with exstrophy of the cloaca sequence had a dysplastic, markedly hypo-plastic right tibia with deformity of the right foot. Note the severity of the abnormal skin dimple.
Figure 1.66. Ulceration of the skin, which was present at birth in this infant, occurred as a result of intrauterine pressure on the fetus.
Figure 1.65. This infant with exstrophy of the cloaca sequence had a dysplastic, markedly hypo-plastic right tibia with deformity of the right foot. Note the severity of the abnormal skin dimple.
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