Isolated Faun Tail at Thoracic Level

Introduction

Faun tail is a congenital localized hypertrichosis occurring over posterior midline, which can be a marker for underlying spinal defects. It presents as a circumscribed, triangular or lozenge shaped patch of terminal hair. The commonest site of involvement is the lumbosacral area [1]. While Faun tail itself is a rare entity, its presentation at thoracic level is even rarer [2].

Case Report

A 14-year old female presented with a patch of excessive and coarse hair growth over mid-thoracic region since birth. She was born of a non-consanguineous marriage, with no family history of similar lesions. She had normal developmental milestones. Her only concern was cosmetic appearance, with no associated history of back pain, bladder or bowel incontinence or muscle weakness.

Dermatological examination revealed a lozenge shaped area of 6x3cms with tuft of long terminal hair (Figure 1). No associated pigmentary changes, subcutaneous lipoma or dermal sinuses were noted. Her neurological examination was found to be normal. As this entity is a known cutaneous marker of spinal dysraphism, further radiological studies were warranted. However, Radiography and Magnetic Resonance Imaging were both found to be normal. Hence, this was a case of isolated faun tail nevus.

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The treatment undertaken was Laser hair removal for cosmetic improvement, using a triple wavelength laser (755+810+1064nm; Dermaindia, Tamil Nadu, India). Parameters used were- 14x14mm spot size, frequency 4-6 Hz, Pulse Width 100ms and a gradually increasing Fluence (ranging 18-26 J/cm2). Laser sittings were performed at 6-8 weekly intervals. Ice-packs were used prior to treatment to reduce any discomfort and avoid paradoxical hypertrichosis in surrounding areas. We noted good cosmetic improvement in density and character of hair after 6 sittings (Figure 2).

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Discussion

Faun tail is a form of localized hypertrichosis occurring over posterior midline most commonly reported over lumbar region. Our patient presented with involvement at the mid thoracic level. A literature search revealed a single such case reported in the past [2].

Faun tail nevus is known to be associated with underlying spinal dysraphism due to failure of fusion of the caudal neuropore [1, 3]. Upto 75% patients with occult spinal dysraphism present with singular or combinations of median or paramedian spinal cutaneous lesions. The lesions can include faun tail, human tail, subcutaebous lipomas, port win stains, dermal sinuses, hemangiomas, pigmentary nevi, deviation of gluteal furrow and dimpling.

Hence, it is mandatory for patients presenting with these to undergo neurological and radiological examination [4]. The case reported is that of an isolated Faun tail, without any associated spinal or neurological defect.

The management of these patients depends on the extent of involvement and in case of presence of spinal dysraphism a multidisciplinary approach is mandated. Surgical management can also be required to reduce neurological disability, if present [3]. To overcome the psychological distress associated with the hypertrichosis, permanent hair reduction with various modalities can be done. These include electrolysis, intense pulsed light and laser hair removal. Lasers most frequently used include diode, Nd:Yag, ruby and alexandrite. The choice of laser depends on the darkness of hair and the skin type. The principle of laser hair reduction is thermal destruction due to selective absorption of energy by the melanin in hair follicle [5, 6].

We are reporting this case for the rarity of presentation of faun tail at thoracic level, as opposed to the commoner lumbosacral involvement.