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Gautam A, Frieden IJ, Shah SD, Witman PM, Harfmann K, Bradley F, Blei F, Pope E, Alsumait A, Gupta D, Covelli I, Streicher JL, Cotton C, Tollefson M, Nguyen H, Hunt R, Buros A, Fernández Faith E. Clinical characteristics of infantile hemangiomas with aggressive, persistent, and destructive ulceration. Pediatr Dermatol 2023; 40:996-1002. [PMID: 37845188 DOI: 10.1111/pde.15444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND/OBJECTIVES Ulceration is a common complication of infantile hemangioma (IH). Severe, persistent ulceration occurs in a minority of patients. This study aims to characterize the clinical features of IH with aggressive ulceration (AU). METHODS Multicenter retrospective study of clinical features of IH with AU. RESULTS Thirty-five patients with AU were identified and included in the study. The majority of AU occurred in segmental IH (23/35, 65%). Segmental IH with AU were large (≥10 cm2 ; 16/23, 69%, p < .001) with a thin (<3 mm) superficial component (16/23, 69%, p < .001). Localized IH with AU had a thick (>3 mm) superficial component (11/12, 92%, p < .001). All diaper area IH with AU (9/35) were segmental with thin superficial component (100%, p = .02). IH with AU in the head/neck (10/35) were more commonly localized (67%) and mixed (62.5%), while segmental, thick superficial morphology was more common on trunk (9/35) and upper extremities (7/35). CONCLUSIONS IH resulting in AU differ in clinical features by anatomic site. Those in the diaper area are nearly always segmental with thin superficial component, whereas other sites tend to be localized, mixed, with thick superficial component. These distinct phenotypes may prove useful in the clinical setting for physicians to identify patterns of IH ulceration with increased risk of aggressive, persistent ulceration.
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Affiliation(s)
- Ayushi Gautam
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Sonal D Shah
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Patricia M Witman
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katya Harfmann
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Flora Bradley
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Francine Blei
- Department of Pediatrics, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Elena Pope
- Division of Pediatric Dermatology, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anwar Alsumait
- Division of Pediatric Dermatology, The Hospital for Sick Children and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Deepti Gupta
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Isabela Covelli
- Department of Pediatrics, Division of Dermatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jenna L Streicher
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Colleen Cotton
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Dermatology, Children's National Hospital, Washington, DC, USA
| | - Megha Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Henry Nguyen
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Raegan Hunt
- Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Buros
- Pediatric Dermatology Research Alliance, Portland, Oregon, USA
| | - Esteban Fernández Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
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Stănciulescu MC, Dorobantu FR, Boia ES, Popoiu MC, Cerbu S, Heredea R, Iacob ER, Cimpean AM, Caplar BD, Popoiu AV. "Face(s)" of a PHACE(S) Syndrome Patient before and after Therapy: Particular Case Report and Review of Literature. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121970. [PMID: 36553413 PMCID: PMC9776585 DOI: 10.3390/children9121970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
A rare, uncommon disorder called PHACE(S) (P-posterior fossa anomalies, H-hemangioma, A-arterial anomalies, C-cardiac anomalies, E-eye anomalies, and S-sternal cleft) of unknown etiology was rarely reported. Children are susceptible to developing PHACE(S) syndrome from the moment they are born. It may be challenging for a physician to appropriately diagnose and treat children with PHACE due to the multifaceted nature of the disease and the extensive range of consequences that may be associated with it. A one-month-old newborn girl was admitted to hospital with extensive, multiple facial infantile hemangiomas, ulceration of the lower lip hemangioma-like lesion, cardiovascular, sternal, and neurological concomitant malformations. Five days following the initial application of the medication, systemic treatment with propranolol and topical treatment with silver sulfadiazine produced their first noticeable benefits. The lip ulceration was mostly healed and facial hemangioma started to regress. The regression continued under therapy and this effect persists for 6 months since Propranolol therapy ended. No cardiovascular or neurological clinical events have been registered during follow-up. The present case has three peculiarities: (1) high number of facial hemangiomas; (2) presence of subependymal cyst not yet reported in the literature associated with PHACE syndrome; and (3) lack of cardiovascular events during therapy knowing that these events frequently appear in PHACE syndrome patients.
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Affiliation(s)
- Maria-Corina Stănciulescu
- Department XI/Pediatric Surgery, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Emergency Hospital for Children Louis Turcanu, 300041 Timisoara, Romania
- Center of Expertise for Rare Vascular Disease in Children, Louis Turcanu Children Hospital, 300041 Timisoara, Romania
| | - Florica Ramona Dorobantu
- Department of Neonatology, Faculty of Medicine and Pharmacy, University of Oradea, 3700 Oradea, Romania
| | - Eugen Sorin Boia
- Department XI/Pediatric Surgery, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Emergency Hospital for Children Louis Turcanu, 300041 Timisoara, Romania
- Center of Expertise for Rare Vascular Disease in Children, Louis Turcanu Children Hospital, 300041 Timisoara, Romania
| | - Marius-Călin Popoiu
- Department XI/Pediatric Surgery, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Emergency Hospital for Children Louis Turcanu, 300041 Timisoara, Romania
- Center of Expertise for Rare Vascular Disease in Children, Louis Turcanu Children Hospital, 300041 Timisoara, Romania
| | - Simona Cerbu
- Center of Expertise for Rare Vascular Disease in Children, Louis Turcanu Children Hospital, 300041 Timisoara, Romania
- Department XV of Orthopaedics, Traumatology, Urology and Medical Imaging, Discipline of Radiology and Medical Imaging, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Rodica Heredea
- Emergency Hospital for Children Louis Turcanu, 300041 Timisoara, Romania
- Center of Expertise for Rare Vascular Disease in Children, Louis Turcanu Children Hospital, 300041 Timisoara, Romania
- Department V/Division of Clinical Practical Skills, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Emil Radu Iacob
- Department XI/Pediatric Surgery, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Emergency Hospital for Children Louis Turcanu, 300041 Timisoara, Romania
- Correspondence: (E.R.I.); (A.M.C.); Tel.: +40-720-060-955 (A.M.C.)
| | - Anca Maria Cimpean
- Center of Expertise for Rare Vascular Disease in Children, Louis Turcanu Children Hospital, 300041 Timisoara, Romania
- Department of Microscopic Morphology/Histology, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Angiogenesis Research Center Timisoara, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Correspondence: (E.R.I.); (A.M.C.); Tel.: +40-720-060-955 (A.M.C.)
| | - Borislav Dusan Caplar
- Doctoral School in Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Anca Voichita Popoiu
- Emergency Hospital for Children Louis Turcanu, 300041 Timisoara, Romania
- Center of Expertise for Rare Vascular Disease in Children, Louis Turcanu Children Hospital, 300041 Timisoara, Romania
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Braun M, Metry D, Frieden IJ, Antaya RJ, Mancini AJ, Kohn LL. Persistent dysesthesias in involuted infantile hemangiomas: An uncommon complication in a common condition. Pediatr Dermatol 2021; 38:1061-1065. [PMID: 34339535 DOI: 10.1111/pde.14743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Infantile hemangiomas (IHs) are common benign vascular tumors of infancy. IHs tend to grow in the first few months of life and then gradually involute over years, often leaving fibrofatty residua or textural changes in their place. Classically, these lesions are painless throughout their entire natural history; however, we now report on seven patients with involuted IH with intermittent but persistent sensory symptoms. METHODS This is a multicenter case series in which members of the Birthmarks Focused Study Group of the Pediatric Dermatology Research Alliance (PeDRA) and the Hemangioma Investigator Group contributed patients with IH and dysesthesias from their clinical practices. Charts were then reviewed to document clinical details. RESULTS Seven patients were included, presenting at an average age of 14.6 years (range 3-48 years) for complaints related to discomfort in the region of involuted IH. The majority (6/7) reported pain or tenderness to the area. One patient reported pruritus. All patients reported intermittent symptoms. The length of symptoms ranged between 4 months and 5 years. Treatment was attempted in 5/7 patients. Ice, oral propranolol, topical capsaicin, and intralesional triamcinolone partially improved symptoms. CONCLUSIONS Persistent cutaneous dysesthesias were present in seven patients, in most cases many years after completion of involution. Further research is needed to fully elucidate the pathophysiology and optimal treatments for this IH complication.
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Affiliation(s)
- Mitchell Braun
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Richard J Antaya
- Departments of Dermatology and Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Anthony J Mancini
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lucinda L Kohn
- Division of Pediatric Dermatology, Department of Dermatology, University of Colorado Anschutz Medical College, Aurora, CO, USA
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