Ulcerated hemangiomas: clinical features and management

Hemangioma is the most common tumor of infancy and ulceration is the most frequent complication of hemangioma. The purpose of this report was to review the clinical features and management of ulcerated hemangioma. A retrospective study of ulcerated hemangioma at the outpatient pediatric dermatology clinic, King Chulalongkorn Memorial Hospital from 1992 to 2001 was performed. The medical records of 41 patients were reviewed. Twenty-eight females and 13 males were seen with a female/male ratio of 2.2: 1. Superficial hemangioma was the most common type (51%). Head and neck were the most frequently involved sites, affecting 21 cases (51%). Ulcerated hemangiomas were found on extremities, torso, and perineum of 9 patients (22%), 6 patients (15%) and 5 patients (12%), respectively. Ulceration was developed at a mean age of 3.9 months (range, 1-7 months). Conventional treatment with topical and/or systemic antibiotic was successfully used in 19 patients (46%). Oral prednisolone was used in 4 patients with large hemangiomas. The mean duration of treatment with oral prednisolone was 12 months. Flashlamp-pumped pulsed-dye laser (FPDL) was used in 16 patients who failed topical and/or systemic antibiotic. Fifteen patients (94%) healed within 1 to 3 treatments. Excision was done on a small superficial hemangioma on the cheek. In conclusion, head and neck were the most common sites of ulcerated hemangioma. Topical antibiotics and/or systemic antibiotics could be used as the first-line management of ulcerated hemangioma. FPDL was very effective in the treatment of ulcerated hemangioma.