Which infantile hemangiomas are prone to ulceration?

Updated: Nov 09, 2020
  • Author: Richard J Antaya, MD; Chief Editor: William D James, MD  more...
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Ulceration occurs in 10-15% of infantile hemangiomas, especially combined superficial and deep lesions. The cause of ulceration is not clear but may be a result of outstripped blood supply to the overlying skin or secondary to the action of certain cytokines.

Ulceration usually occurs in tense, rapidly proliferating hemangiomas and occurs more commonly in the anogenital region, lip, and chest, although any site may develop an ulcer. The ulcerations are extremely painful and result in scar formation upon healing, which may take months. A white discoloration seen early in the course (usually within the first 3 months of life), mimicking that seen in early involution, may herald an impending ulceration, particularly in segmental infantile hemangiomas. [48]

Secondary infection can occur, but cellulitis, abscess, and bacteremia are rare.

While intermittent bleeding is common, serious hemorrhage appears to be rare. Life-threatening arterial hemorrhage has been reported in at least 7 infants, mostly complicating segmental hemangiomas of the head and neck. Closer observation and imaging studies to assess underlying vasculature may be helpful in very high-risk cases. [49]

Treatment for ulcerated hemangiomas includes bio-occlusive dressings (especially hydrocolloid dressings), topical anesthetics like lidocaine jelly 2% for associated pain, pulsed-dye laser (PDL) surgery, topical timolol (warning: monitor for systemic absorption), oral propranolol, becaplermin gel (human recombinant platelet-derived growth factor), [50] external compression therapy (for limb lesions), and, occasionally, topical or oral antibiotics. [51] PDL surgery has been reported to be effective for ulcerated superficial hemangiomas and often decreases pain, even before the ulcer has reepithelialized. [52]

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