Management of Perineal Hemangiomas

These hemangiomas commonly ulcerate. Frequent diaper change is important in these patients. Laser treatment should be considered especially if the hemangioma ulcerates which is unresponsive to appropriate wound care. Systemic steroids should also be considered in some patients.

Wound Care: Thin hydrocolloid wound or zinc paste dressing replaced every 3 days is advisable to minimize the pain and lessen the urine and stool contamination. If the ulceration enlarges and/or becomes infected, systemic antibiotics (erythromycin) should be considered. Some physicians recommend open wet povidone iodine or saline compresses, very gentle cleansing with povidone iodine, 10% solution, for 5 to 10 minutes and application of topical bacitracine or mupirocin ointment four times daily. For extensive infections, a systemic antistaphylococcal antibiotic for 14 to 21 days is recommended. Also, leaving the diaper off for an hour or so after each change is recommended. For protecting the ulcerated area, occlusive dressings (e.g. Duoderm pads) can be used. 

References: Moroz B. Pediatric Dermatology 1997;14:57-83 / A.M. Margileth. Pediatric Dermatology 1997;14:57-83 / Goldberg GN. Pediatric Dermatology 1997;14:57-83  

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