title: Early white discoloration of infantile hemangioma: a sign of impending ulceration.
abstract: OBJECTIVE
  To evaluate the relationship between early white discoloration of infantile hemangioma (IH) and ulceration.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A case series of 11 infants with early white discoloration of IH are described. An additional 55 infants with IH, aged 3 months, were evaluated retrospectively from a photograph archive to further explore the relationship between early white discoloration and presence or development of ulceration.
  
  
  METHODS
  Patient demographics and hemangioma size, location, and subtype are documented. Sensitivity and specificity of white discoloration in relationship to ulceration are estimated.
  
  
  RESULTS
  Ten of the 11 infants in the case series were girls (90%); all IHs were of segmental or indeterminate subtype. Average age at first ulceration was 2.6 months, with average age at healing 5.2 months. No intervention halted progression of ulceration. Of the 55 additional 3-month-old infants, 14 had white discoloration and 12 of these 14 had or developed ulceration (86%). When the hemangioma was either white or slightly white, sensitivity for predicting ulceration was 1.00 (95% confidence interval [CI], 0.78-1.00), with a specificity of 0.68 (95% CI, 0.51-0.81). In contrast, in infants with either slightly white or no white discoloration, the sensitivity for not developing ulceration was 0.80 (95% CI, 0.52-0.96), with a specificity of 0.95 (95% CI, 0.83-0.99), suggesting that a lack of substantial white discoloration early in infancy indicates low risk of ulceration.
  
  
  CONCLUSIONS
  Early white discoloration of infantile hemangioma is highly suggestive of impending ulceration.
authors.affiliation: Department of Pediatric Dermatology, Children's Hospital Boston, 300 Longwood Ave, Fegan 6, Boston, MA 02115, USA. Sheilagh.Maguiness@childrens.harvard.edu
authors.forename: Sheilagh M
authors.initials: SM
authors.lastname: Maguiness
authors.forename: William Y
authors.initials: WY
authors.lastname: Hoffman
authors.forename: Tim H
authors.initials: TH
authors.lastname: McCalmont
authors.forename: Ilona J
authors.initials: IJ
authors.lastname: Frieden
mesh_terms: D005260:Female; D006391:Hemangioma / Q000150:complications / Q000151:congenital / Q000473:pathology*; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors; D012878:Skin Neoplasms / Q000150:complications / Q000151:congenital / Q000473:pathology*; D012883:Skin Ulcer / Q000209:etiology* / Q000473:pathology