Late ulcerating infantile hemangioma responsive to propranolol

Summary: Abstract Body: This study describes an atypical case of a late ulcerating infantile hemangioma (IH) successfully treated with propranolol. A 13-month-old female with no significant medical history presented to our clinic with an ulcerated lesion on the left lateral abdomen, previously diagnosed as an IH. The lesion appeared during her second week of life, grew to 5 x 3 cm, and developed a central ulceration at 12 months, causing considerable pain and discomfort. The patient had been previously treated with topical timolol solution (0.5%) for eight months and metronidazole cream (0.75%) and mupirocin ointment (2%) for one month, all without resolution. Our initial examination revealed a 5 x 2.5 cm erythematous nodule with a 3 x 1 cm central ulceration featuring a yellow, fibrinous base and clear drainage on the left lateral abdomen extending to the back. The patient’s topical regimen was changed to gentamicin ointment (0.1%) with Duoderm dressings, but the ulceration and drainage persisted for another two weeks. At 14 months, oral propranolol (1 mg/kg/day, divided twice daily) was initiated. After one week of propranolol therapy, there was already marked improvement, and the dose was increased to 1.5 mg/kg/day. One week later, the central ulceration was largely closed, with only minor superficial erosions remaining. At 16 months, the lesion had evolved into a well-healing, 4.5 x 2.2 cm erythematous plaque with shiny white scars. Propranolol was tapered without re-ulceration. Ulceration of IHs most commonly occurs while they are proliferating in the first 3-6 months of life, when propranolol therapy is thought to be most beneficial. This case highlights the rare occurrence of late ulceration and demonstrates that propranolol remains effective even when initiated later in the disease course. Nicole Schiraldi^{1, 2}, Richard Rookwood^{1, 2}, Mena Salman³, Haley Heibel^{1, 2}, Julia Gittler^{2, 1} 1. Dermatology, Albert Einstein College of Medicine, Bronx, NY, United States. 2. Dermatology, Montefiore Medical Center, Bronx, NY, United States. 3. The University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States. Clinical Research: Epidemiology and Observational Research