By Gary M. White, MD

Aplasia cutis congenita

Aplasia cutis congenita (ACC) represents an absence of skin in utero. The scalp is most commonly affected. Often, the area has healed by delivery.


A congenital, well circumscribed area of alopecia of the scalp is most common. The skin is often atrophic ("membranous"). If a dense amount of hair is present at the periphery (hair collar sign), the possibility of an underlying meningocele or heterotopic brain tissue should be considered. In severe cases, the child may present with extensive scalp ulceration. Purse-string bunching of the skin around the ulcer may occur [Indian Dermatol Online J 2014;5:103-4].


Most lesions are small and do not require intervention. When older, the child may have the lesion removed for cosmesis.

Large, ulcerated lesions may be allowed to heal, although grafting may be done.

Additional Pictures

Aplasia cutis congenita

Courtesy O. Dale Collins, MD
Aplasia cutis congenita


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