Hemangiomas are the most common tumor of infancy, developing in 4% to 10% of neonates. Most are uncomplicated and appropriately managed with monitoring and counseling, anticipating eventual spontaneous involution with acceptable outcome. However, a significant minority of infants develop associated complications. While caregivers are often concerned about the potential for bleeding, hemorrhage is not common, although disfigurement and ulceration are. These complications often pose a considerable therapeutic challenge. The pain associated with ulceration can be significant enough to disrupt family life. Ulceration is a nidus for infection and precursor to an inevitable scar. Sugarman et al present a particularly challenging case and a novel approach to treatment with commercially available recombinant human platelet-derived growth factor-BB (becaplermin [0.01% Regranex gel]). This product is approved for the treatment of lower extremity diabetic neuropathic ulcers.
Becaplermin is not approved for use in children, but absorption has been minimal in adult studies. The rationale for using becaplermin in this case was to promote tissue repair and wound healing. Although this infant's refractory ulceration responded rapidly after initial application of becaplermin, other variables may have played an important role in wound healing, including hospitalization, more aggressive wound care, intravenous antibiotics, and adequate pain control. Anyone considering this treatment should heed the authors' concerns about the potential to stimulate hemangioma growth.
Siegfried E. Editorial Comment. Arch Dermatol. 2002;138(3):316. doi:10.1001/archderm.138.3.316