The biopsy specimen demonstrated dilated vessels in the upper dermis, consistent with a hemangioma. The results of a viral culture and a direct fluorescent antibody test for herpes simplex were negative. The patient began a 2-week course of prednisone at a dosage of 1 mg/kg per day divided into 2 daily doses, which resulted in significant shrinking of the hemangioma.
Hemangiomas are common tumors of infancy. They have a well-defined course consisting of an early rapid-growth phase over 3 to 10 months, followed by spontaneous resolution over 2 to 10 years. They are true tumors, composed of proliferating endothelial cells, in contrast to vascular malformations, which consist of ectatic vessels with no cellular proliferation.1 Ulceration may occur in 5% to 10% of cases, leading to severe discomfort and pain, scarring, and an increased risk of infection and hemorrhage.2 When ulceration occurs in the perianal or vulvar region, the constant moisture due to soaking in urine and feces from unchanged diapers or constant rubbing by the legs can produce a chronic, nonhealing, friable area.3