Infantile Hemangioma in the Beard Distribution: A Case Report from the Albert Royer Children's University Hospital Center

Abstract

Infantile hemangiomas (IH) are benign vascular tumors characterized by endothelial cell proliferation. Most IH are small and regress spontaneously without requiring treatment. However, depending on their size or location, some IH can cause significant complications, particularly segmental cervicofacial IH, hepatic IH, and subglottic IH. Infants with segmental facial IH are at risk of developing PHACES syndrome (20–30% of cases). The diagnosis of PHACES syndrome is based on the presence of a segmental infantile hemangioma larger than 5 cm associated with one major criterion or two minor criteria (Table 1). Ulceration is the most common complication, affecting approximately 16% of patients. It can cause pain, bleeding, secondary infection, functional impairment, and unsightly scarring. The discovery of propranolol has revolutionized treatment over the last decade. Propranolol can be administered on an outpatient basis in most infants, with the most commonly used dosage being 1–2 mg/kg/day in divided doses. Other more selective beta-blockers such as atenolol may be considered. Laser therapy may also be used for residual hemangiomas with fibro-adipose tissue remnants. Surgery is indicated for disfiguring hemangiomas or those resistant to multiple treatments. We report the case of a 3‑month‑old infant admitted to the neonatal unit of the Albert Royer Children's Hospital for ulceration of the mandibular region extending to the peri‑auricular area, measuring 10 cm in length, with a fibrinous and necrotic base, bordered by an angiomatous plaque and associated with almost complete destruction of the lower lip and right earlobe. This ulceration was associated with sternal agenesis, suggesting PHACES syndrome. She was treated with propranolol at 2 mg/kg/day for 6 months. Complications such as ulceration, secondary infection, and disfigurement were noted. This clinical case highlights the importance of early diagnosis of IH to avoid complications. Spontaneous regression is possible, but for high‑risk forms, oral propranolol remains the first‑line treatment.