The “Hair-Collar” Sign A female neonate was born through vaginal delivery at 39 weeks of gestation. At birth, an elastic protruding hairless nodule measuring up to 1.5 cm in diameter, without enlargement while crying, was noticed on the ver- tex of the scalp (Figure). A ring of high density, dark, coarse, and long hair was noticed around the nodule, forming a “hair collar.” Brain magnetic resonance imaging revealed a lobulated cystic lesion with a stalk through the parietal calvarium. She received resection of the nodule with repair of the periosteum at the age of 3 months, and a pathology study confirmed the diagnosis of meningoencephalocele. After Commens et al described the “hair-collar sign” in 1989, 1 it has been reported to be associated with encephalo- cele, meningocele, 2 aplasia cutis, 3,4 heterotopic glial tissue, or meningothelial hamartoma. 5,6 Rarely, association with vascular malformation such as sinus pericranii has also been reported. 7 As with this case, cranial imaging is recom- mended before any surgical intervention to survey intracra- nial abnormalities. n Mu-Ming Chien, MD Department of Pediatrics National Taiwan University Children’s Hospital Taipei, Taiwan Kai-Lung Chen, MD Hsien-Ching Chiu, MD Department of Dermatology National Taiwan University Hospital Taipei, Taiwan References 1. Commens C, Rogers M, Kan A. Heterotropic brain tissue presenting as bald cysts with a collar of hypertrophic hair. The “hair collar” sign. Arch Dermatol 1989;125:1253-6. 2. Drolet BA, Clowry L, McTigue MK, Esterly NB. The hair collar sign: marker for cranial dysraphism. Pediatrics 1995;96:309-13. 3. Bassi A, Greco A, de Martino M. Aplasia cutis with “hair collar sign”. Arch Dis Child 2014;99:1003. 4. Garcia-Romero MT, Narv oez-Rosales V, Hojyo-Tomoka MT. Bullous aplasia cutis congenita: case report and review of the literature. Indian J Dermatol 2011;56:337-8. 5. Dunham E, Armeni M. Glial choristoma of the temporal bone in a 7-month-old infant. JAMA Otolaryngol Head Neck Surg 2013;139: 944-6. 6. Herron MD, Coffin CM, Vanderhooft SL. Vascular stains and hair collar sign associated with congenital anomalies of the scalp. Pediatr Dermatol 2005;22:200-5. 7. Cheraghi N, Delano S, Csikesz C, Dundamadappa S, Wiss K. Sinus peri- cranii with a hair collar sign. Pediatr Dermatol 2014;31:397-8. Figure. An elastic protruding hairless nodule measuring up to 1.5 cm in diameter, with a ring of dark, coarse, long hairs surrounding the nodule forming a “hair collar.” J Pediatr 2016;168:246. 0022-3476/$ - see front matter. Copyright ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2015.09.081 246