Pain Management for Ulcerated Hemangiomas

摘要

A 3-month-old girl presents with recalcitrant ulcerations within a perineal and perianal hemangioma (Fig. 1). The ulcers have been poorly responsive to conventional therapy, including topical wound care, topical antibiotics, oral antibiotics, and several cycles of pulsed dye laser therapy. Her principal issue has been pain related to the ulcerations, and she has had difficulty sleeping as well as episodic fits of crying.Are there other management strategies that could help this child?Infantile hemangiomas are common vascular tumors that affect between 3% and 10% of all infants, and approximately 15% of patients suffer from ulceration of their hemangiomas (1). Affected areas typically heal with scarring and can be cosmetically or functionally problematic at certain anatomic sites. The most common locations for ulceration include the anogenital area, lip, and neck (1) although lesions on any site can break down. Ulceration results in pain, bleeding (sometimes severe enough to require blood transfusions),and infection (2). Children with ulcerated hemangiomas are often irritable and may have trouble with bathing, feeding, or sleeping (3).