Infantile haemangioma — SCE Dermatology MCQ

Correct answer: A — Urgent assessment for oral propranolol

The correct answer is A, urgent assessment for oral propranolol. This infant has a periocular infantile haemangioma causing partial eyelid closure, a site and behaviour that places it in the high risk category for amblyopia, astigmatism and visual axis obstruction, so specialist review and systemic treatment must happen without delay rather than waiting to see if it regresses. Oral propranolol is the first line systemic therapy for problematic infantile haemangiomas in the UK, acting via vasoconstriction, reduced expression of angiogenic growth factors and induction of apoptosis in proliferating endothelial cells, producing rapid growth arrest and shrinkage. Because the eyelid can occlude the visual axis within weeks, treatment is time critical even though there is no ulceration or cardiac failure, and the decision to treat should be made promptly by a paediatric dermatologist or specialist team after baseline cardiovascular checks. Why the other options are wrong: E. Reassurance until school age: appropriate only for uncomplicated haemangiomas away from functional sites; here the periocular location and eyelid closure carry a real risk of amblyopia if untreated, so watchful waiting risks permanent visual impairment. C. Topical antibiotic ointment alone: antibiotics treat secondary bacterial infection of an ulcerated lesion, there is no ulceration described and antibiotics do nothing to arrest haemangioma proliferation or relieve visual axis obstruction. B. Cryotherapy to the eyelid lesion: cryotherapy is not standard UK management for infantile haemangioma and risks scarring, depigmentation and eyelid tissue damage in a cosmetically and functionally sensitive area. D. High-potency topical steroid as sole therapy: topical steroids have limited penetration and efficacy for proliferative periocular haemangiomas and are not adequate monotherapy when urgent volume reduction is needed to protect vision. Key point: Any infantile haemangioma threatening the visual axis or eyelid function needs urgent specialist assessment for oral propranolol, since delay risks irreversible amblyopia.

Reference: British Society for Paediatric Dermatology, Oral propranolol in the treatment of proliferating infantile haemangiomas: BSPD consensus guidelines, British Journal of Dermatology 2018 (https://academic.oup.com/bjd/article/179/3/582/6732447)