Clinical characteristics, treatment outcomes and prognostic factors of ulcerated infantile hemangioma: 15 years of experience from a pediatric dermatology center in Hong Kong.
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OBJECTIVES: To evaluate the clinical characteristics and therapeutic outcomes of ulcerated infantile hemangioma (IH) and identify prognostic factors of ulcerated IH. METHODS: A single-center retrospective study recruiting patients with ulcerated IH between 2008 and 2023 was conducted. Clinical features and treatment response were analyzed to identify prognostic factors of ulcerated IH and differences in outcomes between early versus late pediatric dermatology referral. RESULTS: A total of 85 patients with ulcerated IH were included. Hemangiomas in the head and neck (H&N) and anogenital regions had an earlier presentation and occurrence of ulceration. Large hemangiomas or ulcers, combined/mixed IH, lip hemangiomas, and positive microbial growth were significant prognostic indicators for longer healing time, more complications and recurrence of ulceration. Cheek hemangiomas, focal IH and later onset ulceration were associated with less scarring and complications. Early referrals before ulceration had less ulcer recurrence (odds ratio [OR] = 0.139; 95% confidence interval [CI]: 0.028-0.693] and secondary complications (OR = 0.081 [95% CI: 0.019-0.348]). Prophylactic topical timolol maleate 0.5% was effective in reducing scar formation (OR = 0.06 [95% CI: 0.005-0.75]) and shortening follow-up duration (P = 0.044). Combination therapy with oral propranolol and pulsed dye laser was the mainstay of treatment (74%). Maintenance laser after ulcer resolution was associated with less ulcer recurrence (OR = 0.27 [95% CI: 0.075-0.96]). CONCLUSION: Early referral of high-risk cases to a pediatric dermatology center before ulceration is crucial. Prophylactic topical timolol before ulceration and maintenance laser therapy after ulcer resolution can improve outcomes.