Ulceration of hemangiomas occurs in up to 5% or 10% of all infants with lesions.1 Ulcerated hemangiomas are quite painful and place the infant at risk for secondary bacterial infection. The pain is often severe enough to prevent an infant from sitting and being held. Many infants with ulcerated hemangio mas in the diaper area will cry with each urination, bowel movement, and diaper change. Ulcerated hemangiomas located on the lip can cause difficulty with feeding. Treatment of ulcerated hemangiomas can be difficult and prolonged. Standard treatment in the past has included local wound care, antibiotics, and/or intralesional or systemic steroids.
The mechanism of ulcer formation is unknown, but the ulcers are thought to develop during the rapid growth phase in mixed superficial and deep hemangiomas. The most common locations for ulcerations to occur have not previously been defined.
In a preliminary report,2 we have previously described the use of the pulsed