A 5-month-old girl is brought to the office by her parents for evaluation of a skin lesion on her buttock. Her parents initially noticed a small, red macule several weeks after her birth and thought it was an insect bite. They have been applying over-the-counter hydrocortisone cream but the lesion has progressively enlarged, especially over the last 2 months. The skin lesion is shown in the image below. Which of the following is the most likely diagnosis in this patient?

Question

A 5-month-old girl is brought to the office by her parents for evaluation of a skin lesion on her buttock.  Her parents initially noticed a small, red macule several weeks after her birth and thought it was an insect bite.  They have been applying over-the-counter hydrocortisone cream but the lesion has progressively enlarged, especially over the last 2 months.  The skin lesion is shown in the image below.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec25c8_d645_8630_bc81_359424d7fbc9_MD0003_00 This patient has a superficial infantile hemangioma, also known as a strawberry hemangioma, which is a benign capillary tumor formed from abnormally proliferating endothelial cells. This vascular birthmark appears during the first few weeks of life as a bright red, sharply demarcated, blanching nodule or plaque. The lesion typically undergoes rapid growth during the first year of life followed by spontaneous regression during childhood. strawberry hemangioma Although most patients require no intervention, beta blockers (eg, propranolol) are recommended for complicated hemangiomas that are disfiguring, ulcerating, disabling (eg, strabismus from eyelid hemangioma), or life-threatening (eg, tracheal lesions). Propranolol promotes involution by causing vasoconstriction and by inhibiting growth factors. eyelid hemangioma (Choice A) Arteriovenous malformations are composed of veins, arteries, and capillaries and appear as purple-red patches with visible veins. They are often warm with a palpable thrill or audible bruit. (Choice B) Cherry angiomas are the most common benign vascular proliferations in adults. They are small, bright red or violaceous macules or papules composed of dilated capillaries and postcapillary venules in the papillary dermis. They are usually widespread on the trunk and increase in number as the patient ages. Cherry angiomas (Choice C) A nevus flammeus, or port wine stain, is a capillary malformation that appears as a blanchable, erythematous patch. These lesions are present from birth and do not regress. nevus flammeus (Choice D) A nevus simplex (eg, macular stain, salmon patch, stork bite, angel kiss) is a blanching, pink patch that most commonly occurs on the eyelid, glabella, and nape of neck. It is typically present at birth and fades spontaneously by age 1-2, although neck lesions may persist with no sequelae. neck lesions (Choice E) A pyogenic granuloma presents as a small, bright red, dome-shaped papule that commonly bleeds. The lesion grows initially and does not involute. pyogenic granuloma Educational objective: Superficial infantile hemangiomas are benign capillary tumors of childhood. They typically appear during the first weeks of life, initially grow rapidly, and regress spontaneously. Complicated lesions may require treatment with beta blockers. References: Infantile hemangiomas: an update on pathogenesis and therapy. (http://www.ncbi.nlm.nih.gov/pubmed/23266916) Diagnosis and management of infantile hemangiomas. (http://www.ncbi.nlm.nih.gov/pubmed/24636652) Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. (http://www.ncbi.nlm.nih.gov/pubmed/23266923) The effectiveness of propranolol in treating infantile haemangiomas: a meta-analysis including 35 studies. (http://www.ncbi.nlm.nih.gov/pubmed/24033819)

A 5-Month-Old Girl Is Brought to the Office by Her