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The “biker-glove” pattern of segmental infantile hemangiomas on the hands and feet - 14/08/14

Doi : 10.1016/j.jaad.2014.04.062 
Nicole A. Weitz, MD a, Michelle L. Bayer, MD b, Eulalia Baselga, MD d, Mauricio Torres, MD d, Dawn Siegel, MD b, Beth A. Drolet, MD b, c, Ilona J. Frieden, MD e, f, Anita N. Haggstrom, MD g,
a Icahn School of Medicine at Mount Sinai, New York, New York 
b Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin 
c Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin 
d Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 
e Department of Dermatology, University of California, San Francisco, California 
f Department of Pediatrics, University of California, San Francisco, California 
g Department of Dermatology and Pediatrics, Indiana University, Indianapolis, Indiana 

Reprint requests: Anita N. Haggstrom, MD, Department of Dermatology and Pediatrics, Indiana University, 545 Barnhill Dr, EH 139, Indianapolis, IN 46202.

Abstract

Background

Infantile hemangiomas (IH) on the extremities have not been systematically studied.

Objective

We sought to describe the clinical characteristics and distribution patterns of IH affecting acral surfaces and to explore the relationship among these patterns, limb development, and IH pathogenesis.

Methods

This was a retrospective multicenter cohort study. Photographic archives from 4 tertiary pediatric dermatology referral centers were searched for patients with IH larger than 1 cm and involving 1 or more digit. Hemangioma location, distribution, and morphologic subtype were recorded. Medical records were reviewed for demographic and clinical data.

Results

In all, 73 patients were identified. The most common IH pattern resembled that of a “biker glove” (73%), followed by localized IH on the distal digits (14%), segmental IH extending over the distal digits (8%), and intermediate patterns (5%). Overall, 63% of acral IH were segmental, 26% indeterminate, and 11% localized. Five patients had associated structural anomalies. Complications were noted in 33% of cases.

Limitations

Limitations were retrospective study design; selection bias based on recall and photography; documentation and follow-up were not standardized across institutions; and treatment information may not reflect current approaches.

Conclusion

Acral IH display specific patterns and are associated with a relatively high risk of ulceration.

Le texte complet de cet article est disponible en PDF.

Key words : acral, embryology, foot, hand, hemangioma, hypoxia, pathogenesis

Abbreviations used : IH, IH-MAG, LUMBAR, PHACE


Plan


 Funding sources: None.
 Disclosure: Dr Frieden is a consultant to Pierre Fabre. Drs Weitz, Bayer, Baselga, Torres, Siegel, Drolet, and Haggstrom have no conflicts of interest to declare.
 Two cases included in this series have been previously reported:
 Case 1:
 Nabatian AS, Milgraum SS, Hess CP, Mancini AJ, Krol A, Frieden IJ. PHACE without face? Infantile hemangiomas of the upper body region with minimal or absent facial hemangiomas and associated structural malformations. Pediatr Dermatol 2011;28:235-41.
 Case 2:
 Metry D, Frieden IJ, Hess C, Siegel D, Maheshwari M, Baselga E, et al. Propranolol use in PHACE syndrome with cervical and intracranial arterial anomalies: collective experience in 32 infants. Pediatr Dermatol 2013;30:71-89.
 Durr ML, Meyer AK, Huoh KC, Frieden IJ, Rosbe KW. Airway hemangiomas in PHACE syndrome. Laryngoscope 2012;122:2323-9.
 Drolet BA, Pope E, Juern AM, Sato T, Howell B, Puttgen KB, et al. Gastrointestinal bleeding in infantile hemangioma: a complication of segmental, rather than multifocal, infantile hemangiomas. J Pediatr 2012;160:1021-6.


© 2014  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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P. 542-547 - septembre 2014 Retour au numéro
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