Elsevier

The Journal of Pediatrics

Volume 151, Issue 6, December 2007, Pages 684-689.e1
The Journal of Pediatrics

Original article
Multicenter Prospective Study of Ulcerated Hemangiomas

https://doi.org/10.1016/j.jpeds.2007.04.055Get rights and content

Objective

To identify clinical features of infants with ulcerated infantile hemangiomas.

Study design

Cross-sectional analysis was conducted within a prospective cohort study of children with infantile hemangiomas. Children younger than 12 years of age were recruited. Demographic and prenatal/perinatal information was collected. Hemangioma size, location, subtype, course, complications, and treatments were recorded.

Results

One thousand ninety-six patients were enrolled, and 173 (15.8%) patients experienced ulceration. Ulceration occurred in 192 (9.8%) of 1096 total hemangiomas. Hemangiomas with ulcerations were more likely large, mixed clinical type, segmental morphologic type, and located on the lower lip, neck, or anogenital region. Ulceration occurred at a median age of 4 months, most often during the proliferative phase. Children with ulcerated hemangiomas were more likely to present to a pediatric dermatologist at a younger age and to require treatment. Bleeding occurred in 41% of ulcerated lesions but was rarely of clinical significance. Infection occurred in 16%.

Conclusions

Ulceration occurs in nearly 16% of patients with infantile hemangiomas, most often by 4 months of age, during the proliferative phase. Location, size, and clinical and morphologic type are associated with an increased risk for development of ulceration.

Section snippets

Methods

A prospective cohort study was initiated in September 2002 by members of the Hemangioma Investigator Group at 7 U.S. academic pediatric dermatology clinics and 1 international site in Barcelona, Spain. The institutional review board at each participating institution approved the study protocol, and patients’ caregivers provided signed informed consent at the time of enrollment. All investigators were trained in study procedures, data collection, and hemangioma subtype classification by

Results

One thousand ninety-six patients were enrolled over a 13-month period. Enrolled patients had a total of 1960 hemangiomas, and detailed follow-up information was available for 1576 of these. The 384 hemangiomas without detailed follow-up were uncomplicated lesions present on patients with more than 1 hemangioma. Patient characteristics are summarized elsewhere (Haggstrom AN, et al, unpublished data).

The complication of ulceration with or without bleeding was noted in 173 (15.8%) patients. Only

Discussion

Infantile hemangiomas are among the most common of soft tissue tumors in children. Although most lesions are uncomplicated and easily managed by watchful waiting and anticipatory guidance, a significant number may result in diminished quality of life and function- or life-threatening complications.

Ulceration is the most common complication.2, 3, 4, 5 The specific mechanisms causing ulceration are poorly understood. Although historically some believed that ulceration might herald involution,

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Supported by the Dermatology Foundation and the American Skin Association.

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