Dermatology: Practical and Conceptual


Image Letter  |  Dermatol Pract Concept 2020;10(4):2020073 1

Dermatology Practical & Conceptual

Case Presentation 

Infantile hemangioma is a common benign vascular pro-

liferation 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, lacu-

nae (yellow arrow) and vascular structures/red dots (green 

arrow) (Figure 1B), appeared later on at the 3-month fol-

low-up visit once the lesion had flattened, and subsequently 

lacunae became empty (white asterisk) and the entire eryth-

ema was replaced by brown diffuse pigmentation (red arrow) 

and dots representing residual pigmentation (Figure 1D).

Teaching Point

Dermoscopic evaluation of hemangioma may help to assess 

the response of treatment.

References

1.  Piccolo V, Russo T, Moscarella E, et al. Dermatoscopy of vascular 

lesions. Dermatol Clin. DOI: 10.1016/j.det.2018.05.006. PMID: 

30201148. 

Dermoscopic Evaluation of Infantile Hemangioma 
Treated With Topical Timolol

Rubina Jassi1, Sarita Sanke1, Ram Chander1

1 Department of Dermatology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India

Key words: hemangioma, infantile hemangioma,  timolol, dermoscopy

Citation: Jassi R, Sanke S, Chander R. Dermoscopic evaluation of infantile hemangioma treated with topical timolol. Dermatol Pract 
Concept. 2020;10(4):e2020073. DOI: https://doi.org/10.5826/dpc.1004a73

Accepted: March 25, 2020; Published: October 26, 2020

Copyright: ©2020 Jassi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License BY-
NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and 
source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Sarita Sanke, MD, DNB, Department of Dermatology, Lady Hardinge Medical College & Associated Hospitals, 
Shivaji Stadium Bus Terminal, Shaheed Bhagat Singh Marg, Connaught Place, New Delhi, 110001, India.  
Email: sankesarita@gmail.com



2 Image Letter  |  Dermatol Pract Concept 2020;10(4):2020073

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).

A B

C D