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Year : 2019  |  Volume : 20  |  Issue : 1  |  Page : 87-89

Segmental infantile hemangioma mimicking michelin tire baby syndrome


Department of Dermatology, Venereology and Leprosy, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Date of Web Publication14-Dec-2018

Correspondence Address:
Dr. Isha Gupta
708-A/18, Near Adarsh School, Arya Nagar, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_50_18

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How to cite this article:
Gupta I, Aggarwal K. Segmental infantile hemangioma mimicking michelin tire baby syndrome. Indian J Paediatr Dermatol 2019;20:87-9

How to cite this URL:
Gupta I, Aggarwal K. Segmental infantile hemangioma mimicking michelin tire baby syndrome. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 Mar 21];20:87-9. Available from: http://www.ijpd.in/text.asp?2019/20/1/87/247556



Sir,

A 6-month-old infant full term with a birth weight of 3.5 kg born by normal vaginal delivery presented with ulcerated red-colored raised lesion over the left hand and forearm since birth. Lesion started from hand and rapidly increased in size and thickness to attain its present size. Antenatal history of the mother was uneventful. On dermatological examination, well-defined, erythematous plaque thrown into circumferential folds was present on dorsal and palmar aspect of the left hand sparing distal aspect of the left thumb and fingers [Figure 1] and [Figure 2]. Plaque involved both dorsal and flexor aspects of the forearm and extended up to the elbow with sparing of medial aspect in the upper one-third of the forearm. Plaque was nontender, firm in consistency, compressible, but nonpulsatile. A well-defined ulcer measuring 3 cm × 2 cm was present in one of the folds. Ulcer has well-defined regular edges, punched out margins, and base covered with purulent slough.
Figure 1: Well-defined, erythematous plaque thrown into circumferential folds present on dorsal aspect of the left hand and forearm

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Figure 2: Plaque thrown into circumferential tiers present on flexor aspect of forearm and palms with sparing of distal thumb and fingers (Biker's glove pattern)

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On routine investigations, complete hemogram and liver and renal function tests were within normal limits. X-ray of the left hand revealed no bony abnormality. Biopsy was not done due to parents' refusal. Based on the history and clinical findings, diagnosis of infantile segmental hemangioma with ulceration was kept. The patient was prescribed topical timolol and oral and topical antibiotics for ulcer.

Infantile hemangiomas (IHs) are benign proliferations of the endothelial cells and their supporting tissues and represent the most common benign tumors of infancy.[1] The phases of growth include early proliferation with a rapid increase in size, late proliferation with continued growth at a slower rate, plateau, and involution. Hemangiomas tend to “mark out their territory” early on, subsequently undergoing primarily volumetric rather than centrifugal growth.[2] Hemangioma is caused by temporary regional tissue hypoxia in early fetal development stimulating proliferation of hematopoietic stem cells.[3] Kleinman et al. demonstrated increase in hypoxia-induced mediators for stem/progenitor cell trafficking in children.[4] About 50% of hemangiomas are reported on head and neck.[1] Upper limb involvement is relatively rare with 15% involvement.[5] IH of the extremities (IHE) is of 3 types focal, segmental and IH-MinimalArrest Growth. pattern.[3] Segmental hemangiomas are defined as IH that extends over a specific cutaneous segment, are plaque-like, and are usually larger than focal IH (>2 cm) as in our case.[3] On the hands and feet, segmental IH can be defined as those involving 2 or more contiguous digits or >25% of an acral surface, both dorsal and ventral surfaces, or crossing multiple joints.[6] The location of IHE may be related to variant anatomy of arterial supply during embryo-fetal development.[3] Sparing of distal phalanx of the thumb in our case called as Biker's glove pattern could be attributed to different vascular anatomy of digital arteries. The back of each finger up to its middle phalanx is supplied by two thin digital arteries arising from the deep palmar arch (mainly supplied by the radial artery). The palmar sides of the fingers and their distal dorsal tips are supplied by two stronger palmar digital arteries arising from the superficial palmar arch (mainly supplied by the ulnar artery).[3] Weitz et al. reported Biker's glove pattern in 73% patients of segmental IHs on the hands and feet.[6] Ulceration was reported only in 5.5% of patients of IHE.[3]

Hence, upper extremity involvement, presence of ulceration, and unusual presentation in the form of circumferential tiers mimicking Michelin tire baby are the uncommon features of segmental IHE which prompted us to report this case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Haggstrom AN, Garzon MC. Infantile hemangiomas. In: Bolognia JL, Schaffer JV, Cerroni L, editors. Dermatology. 4th ed. USA: Elsevier Limited; 2018. p. 1786-90.  Back to cited text no. 1
    
2.
Chang LC, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, et al. Growth characteristics of infantile hemangiomas: Implications for management. Pediatrics 2008;122:360-7.  Back to cited text no. 2
    
3.
Reimer A, Fliesser M, Hoeger PH. Anatomical patterns of infantile hemangioma (IH) of the extremities (IHE). J Am Acad Dermatol 2016;75:556-63.  Back to cited text no. 3
    
4.
Kleinman ME, Greives MR, Churgin SS, Blechman KM, Chang EI, Ceradini DJ, et al. Hypoxia-induced mediators of stem/progenitor cell trafficking are increased in children with hemangioma. Arterioscler Thromb Vasc Biol 2007;27:2664-70.  Back to cited text no. 4
    
5.
Jacobs BJ, Anzarut A, Guerra S, Gordillo G, Imbriglia JE. Vascular anomalies of the upper extremity. J Hand Surg Am 2010;35:1703-9.  Back to cited text no. 5
    
6.
Weitz NA, Bayer ML, Baselga E, Torres M, Siegel D, Drolet BA, et al. The “biker-glove” pattern of segmental infantile hemangiomas on the hands and feet. J Am Acad Dermatol 2014;71:542-7.  Back to cited text no. 6
    


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  [Figure 1], [Figure 2]



 

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