A 1-month-old girl is brought to the office due to a large birthmark on the right side of the face and scalp. The lesion has become raised and increasingly bright red. There is no bleeding or oozing. Vital signs and growth parameters are normal. The lesion is shown in the exhibit; examination is otherwise unremarkable. MRI of the head and echocardiography reveal no abnormalities. Which of the following is the most appropriate therapy for this patient?

Question

A 1-month-old girl is brought to the office due to a large birthmark on the right side of the face and scalp.  The lesion has become raised and increasingly bright red.  There is no bleeding or oozing.  Vital signs and growth parameters are normal.  The lesion is shown in the exhibit; examination is otherwise unremarkable.  MRI of the head and echocardiography reveal no abnormalities.  Which of the following is the most appropriate therapy for this patient?

Quizplus · Accepted Answer

11ec25c8_d646_2271_bc81_ddd229d4c587_MD0003_00 This infant has an infantile hemangioma, a benign, vascular tumor that presents days to weeks after birth as a bright red, raised plaque, which then proliferates in infancy and regresses in early childhood. Although most simple hemangiomas can be observed with no intervention, certain features (eg, segmental, periorbital) warrant further evaluation or treatment. simple hemangiomas Management of the hemangioma itself depends on size, location, and risk of functional impairment. In this case, this patient's periorbital hemangioma warrants oral beta-blocker therapy (eg, propranolol) due to risk of visual impairment. During the proliferative phase, rapid growth of hemangiomas located near the eye can lead to physical obstruction of sight causing strabismus and amblyopia or corneal pressure causing astigmatism. Propranolol acts by local vasoconstriction to limit further growth, promoting regression of the lesion. Large, segmental hemangiomas, such as this patient's, are also at increased risk of ulceration, scarring, and permanent disfiguration without pharmacotherapy, and most patients respond to propranolol within months with nearly complete resolution of the hemangioma. (Choice A) Pulsed dye laser therapy is first-line management for port-wine stains, which present as flat, red-purple patches that do not proliferate in infancy. Laser therapy is rarely used for hemangiomas unless they are ulcerated. port-wine stains (Choice B) The risk of scarring from hemangioma excision is far higher than from observation or pharmacotherapy. Because the natural course of most hemangiomas is progressive involution, surgical intervention is typically avoided. (Choice D) Topical metronidazole is used to treat rosacea, which presents in adults with localized facial (eg, nose/cheeks) erythema with or without pustules and papules. This patient's age and raised, bright red, unilateral plaques are inconsistent with rosacea. rosacea (Choice E) Topical retinoids (eg, tretinoin) are used to treat adolescent acne vulgaris, which can present as papulopustular lesions. Neonatal acne may look like adolescent acne, but it presents in early infancy and typically requires no treatment. Moreover, localized, increasingly red, raised plaques are inconsistent with this diagnosis. Neonatal acne Educational objective: Although most infantile hemangiomas require no treatment, propranolol should be given for those that increase risk of functional impairment (eg, periorbital) or ulceration/scarring (eg, large, segmental). Propranolol causes hemangioma regression by promoting local vasoconstriction. References: Infantile hemangioma: a review of current pharmacotherapy treatment and practice pearls. (http://www.ncbi.nlm.nih.gov/pubmed/33041713) PHACE syndrome. (http://www.ncbi.nlm.nih.gov/pubmed/30969544)

A 1-Month-Old Girl Is Brought to the Office Due to a Large