Ulcerated Infantile Hemangioma of the Upper Lip Mimicking a Cleft Lip: A Diagnostic Dilemma

Abstract

Introduction: Infantile hemangiomas (IH) are the most common benign vascular tumors of infancy, typically emerging in the early postnatal period. While most IH follow a self-limiting course, ulceration is a frequent complication, particularly in high-risk anatomical sites such as the perioral region. Ulcerated IH can pose diagnostic challenges by mimicking other ulcerative conditions, including pyoderma gangrenosum and invasive fungal infections. Case Report: We describe a 30-day-old male infant presenting with a rapidly progressive ulcerative lesion of the upper lip, resulting in a cleft lip–like deformity. The lesion originated as an erythematous patch over the philtrum during the second week of life and subsequently evolved into a deep ulcer. Initial differential diagnoses included pyoderma gangrenosum and fungal infection. However, retrospective evaluation of serial neonatal photographs revealed a precursor lesion consistent with IH, enabling a clinical diagnosis. The infant was managed with systemic antibiotics for secondary infection, along with oral propranolol and topical timolol, leading to marked clinical improvement. Conclusion: This case underscores the importance of recognizing early precursor lesions and maintaining a high index of suspicion for IH in atypical ulcerative presentations. Detailed clinical chronology and photographic documentation can be invaluable in establishing the diagnosis. Early identification and prompt treatment are crucial to prevent functional impairment and long-term cosmetic sequelae.