Abstract
•We present a case of abnormal skin overgrowth over an abnormal bony island in a full tern child after misoprostol use.•Central vertex lesions can vary from overgrowth and undergrowth or under formation of tissues.•Careful assessment of any child with skull lesion.•Management algorithm proposes management steps that we applied in our case and can help manage other cases of scalp lesions in pediatric patients.
Congenital scalp lesions rarely occur in children. These lesions are usually noticed at birth and mostly comprise skin and bone tissue loss in the form of acutis aplasia congenita. The management of these lesions is highly dependent on their location and the affected underlying structures.
We report the case of a baby girl who was referred to us after a normal full-term delivery and who had an area of an abnormal overgrowth of skin (skin tag) on the vertex of the scalp, with an area of surrounding alopecia. She was otherwise healthy with no noted congenital anomalies. Apart from a prenatal history of attempted abortion using misoprostol, she had no significant history or congenital anomalies. She underwent a CT scan and an MRI. She also underwent an operation to excise the overgrowth and to address the underlying bone tissue anomaly. Histopathology showed respiratory mucosa heterotopia. We report this unusual case that suggests the need for an algorithm to manage such cases, as well as the need to investigate the possibility of misoprostol teratogenicity and a probable link to heterotopia.
Congenital skin lesions on the scalp should be approached in a multidisciplinary manner to guide their treatment.