Photo Rounds

Large red area on infant’s face

The family of a one-month-old infant brought her in to see the family physician (FP) because of a large red area on the baby’s face. While some pink discoloration was noted at birth, the area had become increasingly red and swollen.

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This patient had a large infantile hemangioma on her face and scalp that needed immediate treatment to prevent amblyopia in the left eye. There was also concern for PHACE (posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities) syndrome. Any large segmental hemangioma on the face could be part of PHACE syndrome and therefore would require an evaluation of the child’s eyes, central nervous system, and heart.

The FP referred the patient to a pediatric dermatologist who initiated oral propranolol therapy. The workup for PHACE syndrome was negative, and the hemangioma responded well to the propranolol.

Photo courtesy of John Browning, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R, Madhukar M. Childhood hemangiomas and vascular malformations. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:636-641.

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