This healthy 10 week old girl was noted to have a red patch on her arm shortly after birth. The patch grew quickly in volume and a large portion of the expanding plaque became necrotic and ulcerated at 4 weeks of age. She was initially treated with 2 mg/kg/day of oral prednisolone without improvement. The ulcer was painful, and several episodes of secondary infection with methicillin staphylococcus were treated with oral and parenteral antibiotics. At 8 weeks of age the prednisolone was tapered, propranolol 2 mg/kg/day was initiated, and the wound was treated with gentle cleaning and a dressing composed of carboxymethylcellulose and 1.2% ionic silver. The first images dated 10/22 were taken 36 hours after the initiation of propranolol and methylcellulose dressings. Subsequent images taken during dressing changes on 10/25 and 10/28 demonstrate a clean granulating wound base.
large segmental purple plaque with massive central ulceration