A 4-Month-Old Girl with a Red Ulcerated Nodule on the Temporal Area

Abstract

Infantile hemangioma is the most common benign tumor of the infancy that affects 4%–5% of newborns. Infantile hemangiomas are more frequent in Caucasian, premature infants, twins and infants with low birth weight. There is also a female predominance. Infantile hemangiomas are classified as superficial, deep and mixed. They are characterized by triphasic evolution. Precursor lesion is visible as a pale area of vasoconstriction or a telangiectatic pink spot which appears after birth or in the first weeks of life. In early proliferative or growth phase, there is rapid growth during the first three months and gradual growth in months five to eight of life. Plateau phase is observed between six and 12 months of life. Involution phase occurs after the first year of life and continues for several years. Infantile hemangiomas occur on the skin and mucosal surfaces. The head and neck are most commonly affected (60% of cases). This is followed by lesions on the trunk in 25% of cases, and least commonly, on the extremities, seen in 15% of cases. Complications occur in 10–15% of infantile hemangiomas. Infantile hemangiomas do not usually require treatment. In case of complications therapy is recommended. Oral propranolol is the first-line therapeutic option. Also topical beta-blockers such as timolol may be used off-label for small superficial haemangiomas. Topical, intralesional and systemic corticosteroids may be also helpful. The pulse dye laser is recommended in the treatment of residual lesions.