Strawberry naevus (cavernous haemangioma)
Strawberry naevus affects up to 1% of infants. It presents at, or shortly after, birth as a single red lumpy nodule (Fig. 23.40) that grows rapidly for the first few months. Multiple lesions can be present. They will spontaneously resolve with good cosmesis but this may take up to 7 years for complete resolution. Occasionally plastic surgery is needed after resolution to remove residual slack skin. Reassurance of parents is usually all that is required.
Treatment is indicated if:
the lesion interferes with feeding or vision
the lesion ulcerates or bleeds frequently
the lesion is associated with high-output cardiac failure from shunting of large volumes of blood
the lesion consumes platelets and/or clotting factors causing potentially life-threatening haemorrhage ('Kasabach-Merritt syndrome').
The latter two complications are very rare and only tend to occur in large lesions with significant deep vessel involvement.
Figure 23.40 Strawberry naevus (cavernous haemangioma).
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Treatment modalities include intralesional or oral corticosteroids, surgery (for selected lesions), and tunable dye laser (for treating ulceration). Alpha-interferon injections, vincristine or embolization is only used for life-threatening events.
Port-wine stain (naevus flammeus)
Port-wine stain is also called a capillary haemangioma but strictly speaking it is not a haemangioma but is just an abnormal dilatation of dermal capillaries. It presents at birth as a flat red macular area and is commonly found on the face. It does not improve spontaneously and it may become thickened with time. If the lesion is found in the distribution of the first division of the trigeminal nerve it may be associated with ipsilateral meningeal vascular anomalies which can cause epilepsy and even hemiplegia (Sturge-Weber syndrome, p. 1257). If a port-wine stain involves the skin near the eye, glaucoma is a risk and ophthalmic assessment is mandatory.
Treatment of port-wine stains is ideally carried out with the tunable dye laser.
Milia
'Milk spots' are small follicular epidermal cysts. They are small pinhead white papules commonly found on the face of infants. They resolve spontaneously.
Mongolian blue spot
This appears in infants as a deep blue-grey bruise-like area, usually over the sacrum or back, and is occasionally mistaken as a sign of child abuse. It is due to deep dermal melanocytes. It is very common in Oriental children, less common in black Africans and rare in Caucasians. It has usually disappeared by the age of 7 years.
Toxic erythema of the newborn (erythema neonatorum)
Toxic erythema of the newborn is a term used to describe a common transient blotchy maculopapular rash in newborns. The rash is occasionally pustular but the child is not toxic or unwell. It disappears within a few days, spontaneously.
Nappy rash ('diaper dermatitis')
This is an irritant eczema caused by occlusion of faeces and urine against the skin. It is almost universal in babies. The flexures are usually spared, which is a useful differentiating feature from seborrhoeic and atopic eczema. If satellite lesions are present around the edge, it may indicate a superimposed Candida infection. This rash can also occur in the elderly incontinent.
Treatment involves frequent changing of the nappy and regular application of a barrier cream.
Acrodermatitis enteropathica (p. 249)
This is due to a rare inherited deficiency of zinc absorption. It presents 4-6 weeks after weaning, or earlier in bottle-fed babies. There is an erythematous, sometimes blistering, rash around the perineum, mouth, hands and feet. It may be associated with photophobia, diarrhoea and alopecia.
Treatment is with lifelong oral zinc, which seems to override the poor absorption. The response is rapid.
FURTHER READING
Bruckner AL et al. (2003) Hemangiomas of infancy. Journal of the American Academy of Dermatology 48: 477-493.
Harper J, Oranje A, Prose N (eds) (2000) Textbook of Pediatric Dermatology. Oxford: Blackwell Scientific.
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