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LETTER TO EDITOR
Year : 2019  |  Volume : 20  |  Issue : 1  |  Page : 89-90

Late-onset capillary hemangioma: A rare occurrence


1 Department of Dermatology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
2 Department of Dermatology, Skin City Clinic, Camp, Pune, Maharashtra, India
3 Department of Pathology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India

Date of Web Publication14-Dec-2018

Correspondence Address:
Dr. Priyanka Borde Bisht
Skin City Clinic, Nucleus Mall, Opp Commissioner Office, Church Road, Camp, Pune - 411 010, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_66_18

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How to cite this article:
Garg S, Bisht PB, Rao S. Late-onset capillary hemangioma: A rare occurrence. Indian J Paediatr Dermatol 2019;20:89-90

How to cite this URL:
Garg S, Bisht PB, Rao S. Late-onset capillary hemangioma: A rare occurrence. Indian J Paediatr Dermatol [serial online] 2019 [cited 2019 Dec 7];20:89-90. Available from: http://www.ijpd.in/text.asp?2019/20/1/89/247559



Sir,

An 11-year-old boy presented with multiple nontender, vascular papules and nodules, measuring 3–15 mm, over the right upper chest [Figure 1]. They started erupting 2 years back and reached the current size and number over next 7–8 months. Lesions were firm in consistency and noncompressible with a history of profuse bleeding after trauma. There were no new lesions since the past 2 months. Few of them spontaneously resolved over 2–3 months which was hastened after topical application of timolol applied for 6 months, which was stopped a month back.
Figure 1: Multiple vascular papules and nodules over right shoulder and upper chest

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Probable diagnosis of tufted angioma, papillary hemangioma, benign or malignant hemangioma, dermatofibroma protuberans, Kaposi sarcoma, and bacillary angiomatosis wasa considered. Doppler study of the lesions showed highly vascular structures with good vascular connections with deeper structures. Histopathology of one excised lesion revealed polypoidal vasoformative lesion composed of proliferating capillaries arranged in loose stroma with a distinctive lobular architecture consistent with diagnosis of capillary hemangioma [Figure 2].
Figure 2: Polypoidal vasoformative lesion composed of proliferating capillaries arranged in loose stroma with a distinctive lobular architecture (H and E, x 10)

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The patient was treated with intralesional injection of triamcinolone acetonide 10 mg/ml, repeated after every 6 weeks. A total of three injection sessions were done using 3.5 ml, 3 ml, and 2 ml of triamcinolone acetonide in each sitting, respectively. All the vascular nodules and papules resolved completely except for two nodules which resolved to about 90% of their original size. The patient was given clobetasol propionate 0.05% cream to be applied on the two remaining lesions for the next 30 days. The patient has been under follow-up for the past 6 months and has had no recurrence or new lesion since his last injection [Figure 3].
Figure 3: Complete resolution of haemangioma after 3 sessions of intralesional corticosteroid therapy

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Capillary hemangiomas are the most common vascular tumors of infancy and usually appear within the 1st month of life. Their reported prevalence is as high as 10%.[1] Prematurity, low birth weight, female sex, white race, twin births, and advanced maternal age are the risk factors associated with them.[2] None of these were present in this case. The most commonly reported locations for these lesions include the head and neck.[3] Mostly, they resolve over time without major sequelae, but a significant number of untreated cases depending on their location may result in permanent facial disfigurement, visual disturbance, speech difficulties, or life-threatening consequences, such as airway obstruction and congestive heart failure.

Topical, oral, and intralesional corticosteroids have been the mainstay of treatment of capillary hemangiomas and are easily available. However, long-term use can cause serious systemic side effects such as diabetes, osteoporosis, hypertension, Cushingoid features, and cutaneous side effects such as skin atrophy, telangiectasia, and striae.[4] Oral propranolol and topical timolol are now considered safer and equally effective options to corticosteroids. Pulse dye laser and Nd: YAG laser are now frequently being used for ulcerated/voluminous/complicated hemangiomas with or without systemic therapy.[5]

The aim to report this case is to present occurrence of late onset capillary haemangioma which is very rare and to highlight simple and inexpensive treatment of the same, with three injections of intralesional triamcinolone acetonide.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's father has given consent for his son's images and other clinical information to be reported in the journal. The patient's father understands that the name and initials will not be published and due efforts will be made to conceal 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, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, et al. Prospective study of infantile hemangiomas: Clinical characteristics predicting complications and treatment. Pediatrics 2006;118:882-7.  Back to cited text no. 1
    
2.
Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in children. N Engl J Med 1999;341:173-81.  Back to cited text no. 2
    
3.
Hemangioma Investigator Group, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, et al. Prospective study of infantile hemangiomas: Demographic, prenatal, and perinatal characteristics. J Pediatr 2007;150:291-4.  Back to cited text no. 3
    
4.
Boye E, Jinnin M, Olsen BR. Infantile hemangioma: Challenges, new insights, and therapeutic promise. J Craniofac Surg 2009;20 Suppl 1:678-84.  Back to cited text no. 4
    
5.
Sethuraman G, Yenamandra VK, Gupta V. Management of infantile hemangiomas: Current trends. J Cutan Aesthet Surg 2014;7:75-85.  Back to cited text no. 5
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