Infantile hemangioma is a common benign vascular proliferation seen in the pediatric age group. Dermoscopy of hemangioma shows lacunae of variable sizes and dilated vessels against a red to reddish blue background [ 1 ] . We report the dermoscopic evaluation of regression of infantile hemangioma on topical timolol.
A 3-month old infant presented with complaints of a red raised proliferative lesion of 5 × 5 cm over the abdomen since 8–10 days of life. A clinical diagnosis of infantile hemangioma was made. The infant was started on topical timolol 0.5% drops twice a day. Dermoscopic evaluation follow-up (DL 3N, polarized, × 20) was done at 0, 1, 3, 5, and 7 months. The erythema was first to respond, followed by decrease in the depth of the lesion. Black dots (black arrow) represent thrombosed capillaries that disappeared in the initial phase of treatment ( Figure 1A ). White dots (white arrow) represent the eccrine openings that were uninvolved during the entire course of regression ( Figure 1B ). The classical features, lacunae (yellow arrow) and vascular structures/red dots (green arrow) ( Figure 1B ), appeared later on at the 3-month follow- up visit once the lesion had flattened, and subsequently lacunae became empty (white asterisk) and the entire erythema was replaced by brown diffuse pigmentation (red arrow) and dots representing residual pigmentation ( Figure 1D ).
Figure 1 .
(A) Baseline: diffuse red background with multiple eccrine openings, enhanced skin markings, fine white surface, scaling, and thrombosed capillaries (black arrow). (B) 3-month follow-up: lesion flattened, eccrine openings (white arrow), vascular dots (green arrow), and lacunae (yellow arrow) seen more clearly. Scaling and skin markings disappeared. (C) 5-month follow-up: erythema decreased, lacunae and red dots disappeared, brown pigmentation replacing the erythema. (D) 7-month follow-up: diffuse brown residual pigmentation (red arrow) and empty lacunae (white asterisk).
Dermoscopic evaluation of hemangioma may help to assess the response of treatment.