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    Top five treatment mainstays: Ulcerated pediatric hemangiomas

    Managing pain and complications

     

    Treatment mainstays

    Katherine B. Puttgen MDA retrospective review of 169 cases demonstrated that combination therapy was the mainstay of treatment for infantile hemangiomas:

    1. Local wound care was employed in all cases.

    Local wound care involves dressings, barrier creams, and the use of a pulsed-dye laser, says Dr. Lara-Corrales.

    It can be challenging to treat ulcerated hemangiomas that present in sites like the diapering area, notes Dr. Lara-Corrales. In terms of healing these sites, it is problematic to use dressings. Frequent diaper changes are recommended, and paste with a high concentration of zinc oxide should be applied.

    With small ulcerations, or superficial ones, or when the patient is not experiencing a lot of pain, topical timolol can also be used to try to heal the ulceration, says Dr. Lara-Corrales.  

    Katherine B. Puttgen MD, Director, Johns Hopkins Division of Pediatric DermatologyAssistant Professor, Dermatology and Pediatrics, Johns Hopkins University School of Medicine in Baltimore, MD, uses timolol in the treatment of ulcerated infantile hemangiomas, but stresses that careful dosing and monitoring is required because of the potency of timolol.

    Reassuringly, in our cohort of 731 patients, there were no systemic adverse events, such as hypotension or bradycardia, associated with timolol use on ulcerated infantile hemangiomas," said Dr. Puttgen, adding if an ulcerated hemangioma does not heal or is not close to healing within two weeks of initiation of timolol, she will instead use oral propanolol.

    NEXT: Pain management was employed in three quarters of cases

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