Skin Disorders Case

A 2-month-old girl presents with a vascular plaque on the chin that has been present since birth.

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A 2-month-old girl presents with a vascular plaque on the chin that has been present since birth. Parents report it has just started growing.

What is your next step in management of this infantile hemangioma?

A. Otolaryngology consult.

B. Follow-up in 6 months.

C. Interferon. 

D. Magnetic resonance imaging (MRI) to define the extent of the lesion. 

E. Oral propranolol. 

The correct answer is “A.” Hemangiomas in a ‘beard’ distribution (lower lip, chin, mandible or neck) may be a marker for potentially life threatening airway hemangiomas. Referral to otolaryngology (ENT) is essential. Symptoms of stridor, hoarseness, and cough typically occur in the first few months of life concurrent with growth of the lesion. Be aware, not all children with an airway hemangioma have cutaneous lesions. Lumbosacral hemangiomas may be a marker for spinal dysraphism and should be evaluated with MRI of the spine. Large segmental facial hemangiomas are associated with PHACES syndrome (Posterior fossa malformations, Hemangioma, Arterial anomalies, Cardiac anomalies and aortic coarctation, Eye abnormalities, and Sternal clefting or supraumbilical abdominal raphe). Oral propranolol has replaced systemic corticosteroids and interferon for management of complicated hemangiomas. Ulcerated hemangiomas may be treated with pulsed dye laser and wound care. Topical beta-blockers are reserved for superficial infantile hemangiomas.

Sources:
Question & Explanation: Peterson AR, Wood KE. Pediatrics Examination and Board Review. New York, NY: McGraw-Hill Education; 2017.

Photo: Chapter 359 Vascular Tumors and Malformations, Kline MW. Rudolph's Pediatrics, 23e; 2018. 

Leah Carton

Associate Editor - Pediatrics, Dermatology, Geriatrics , McGraw Hill