Incidence and clinical factors associated with ulceration in infantile hemangiomas

J Am Acad Dermatol. 2023 Feb;88(2):414-420. doi: 10.1016/j.jaad.2022.10.047. Epub 2022 Oct 28.


Background: Ulceration is an important complication in infantile hemangiomas (IHs). Prior to the use of β-blockers, the estimated incidence of this complication in a referral population was between 15% and 30%. The incidence and factors associated with ulceration have not been systematically studied since the emergence of β-blocker therapy.

Objective: Examine the incidence and clinical predictors for ulceration in IHs.

Methods: Retrospective study at tertiary referral centers.

Results: Compared with a previous large pre-propranolol cohort study, ulceration occurred at a significantly lower incidence of 11.4%. Clinical factors associated with ulceration included partial segmental morphology, location in the diaper area, and size greater than 5 cm. Higher risk of ulceration in Black patients was observed, suggesting barriers to care including delayed diagnosis and referral to specialty care.

Limitations: Retrospective design at tertiary referral centers.

Conclusion: Compared with reports before the use of β-blockers became widespread, the incidence of ulceration in IHs has decreased. However, it continues to be a relatively frequent complication of IH.

Keywords: incidence; infantile hemangioma; propranolol; risk factors; ulceration; β-blocker.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Cohort Studies
  • Hemangioma, Capillary* / complications
  • Hemangioma, Capillary* / drug therapy
  • Hemangioma, Capillary* / epidemiology
  • Humans
  • Incidence
  • Infant
  • Retrospective Studies
  • Skin Neoplasms* / drug therapy


  • Adrenergic beta-Antagonists