Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital disorder with persistent cutis marmorata, telengiectasia, and phlebectesia, which may be associated with cutaneaus atrophy and ulceration of the involved skin. We herewith report a three month old male baby with CMTC at birth involving left side of the face, upper limbs, both flanks, and left gluteal and left leg with ulceration over the extensor aspects of the left knee joint. The baby had a reticulated bluish purple skin changes all over the body including the face and limb. Although it resembled physiological cutis marmorata, it was strikingly pronounced and defi n i t e ly was unvarying and permanent. A variety of vascular malformation has been described along with this disorder. Etiology is not very clear. Prognoses in uncomplicated cases are good.

Neonatal lupus erythematosus (NLE) is an autoimmune disease affecting the fetus as a result of transplacental transfer of anti-Ro autoantibodies. Typically, it presents in the first few months of life with an annular form of subacute cutaneous lupus erythematosus. We report an infant of NLE presenting at birth with multiple annular erythematous plaques with skin atrophy involving the face, head, and upper trunk. Histopathology of skin biopsy was consistent with subacute cutaneous lupus. The mother was clinically free of disease and had no family history of autoimmune disease. Serology (extranuclear antigens) was positive in both the baby and the mother. This is a rare presentation of a rare disease.

Haemangiomas usually develop within the first few weeks of life, most regressing spontaneously before the age of 7 to 10 years. Some may ulcerate or compromise a vital function, in which case systemic corticosteroids, surgery or radiotherapy may be helpful. All of these treatment modalities are associated with significant morbidity. Treatment with 585nm flashlamp pulsed dye laser is safe and effective in the management of ulcerated and superficial proliferating haemangiomas. We report a retrospective review of 33 children under the age 12 months, who were treated at our centre with 585nm pulsed dye laser over a period of 4 years. Forty eight percent of these children presented with rapidly proliferating haemangiomas causing functional impairment, 40% with ulcerated haemangiomas and others for re-growth after stopping oral treatment. Patients were treated with the 585nm pulsed dye laser (fluence: 5.5-7J/cm2; spot size: 7mm and duration: 0.45s). Patients received treatment until the lesion was almost clear or until lesion failed to respond. All lesions ulcerated haemangiomas healed after an average 3 treatment. Both the physician and parental perception of improvement were analysed based on three parameters, which include reduction in redness, thickness and size. All the haemangiomas showed significant reduction in size, thickness and colour. Less than 1% of patients had atrophic scaring. We conclude that the flashlamp-pulsed dye laser may successfully prevent enlargement and promote involution of superficial haemangiomas with minimal adverse effect. Therapy is most appropriate for patients with ulcerated haemangiomas and haemangiomas at sites of potential functional impairment.

Cutaneous haemangiomas over the spine should be studied with ultrasound then MRI with gadolinium (if abnormalities are present on ultrasound) as they can be associated with intraspinal extension and dysraphic lesions6. Paravertebral extension of haemangioma and mediastinal haemangioma are rare but associated with risk of neurological complications. Our case highlights this potential complication and acts as reminder to physicians that imaging is essential in certain cases of infantile haemangioma.

Introduction: Infantile haemangioma is the most common tumor in infancy. They are extremely heterogenous clinically. Established risk factors for infantile haemangioma include female sex, white ethnicity, prematurity, low birth weight and multiple gestation. There is a lack of demographic studies in the Asian population especially in the Malay ethnic group. Objective: To describe the demographics and clinical characteristics of infantile haemangioma in a tertiary centre in Malaysia. To describe associated complications and the need for therapeutic intervention. To determine whether there is any difference in demographics and clinical characteristics of infantile hemangiomas in a Malaysian population comprising predominantly Malay ethnic group with published reports of Western population. Design Retrospective review of patients with infantile haemangioma referred to the Paediatric Dermatology unit, Kuala Lumpur Hospital between January 2009 and May 2011. Main Outcome Measures: Demographic and clinical characteristics were summarized and compared with data from previous studies. The study included 50 patients (38 females and 12 males) with a mean age of 6.23 months (range 0.1 to 16 months) at presentation. 11(22%) patients were premature. The mean age of onset was 20 days (range 0 to 5 months). 18(37%) patients had a premonitory mark at birth. Of 62 hemangiomas in 50 patients, 45(72.5%) were localized, 5(8.1%) were segmental, 11(17.7%) indeterminate and 1(1.6%) multifocal. The most frequent location of the haemangiomas was in the face with 29(46.8%) lesions, followed by 10(16.1%) lesions in the head and neck, 10(16.1%) lesions in the extremities, 8(12.9%) lesions in the trunk and 5(8.1%) in the perineum. Complications that occurred included ulceration in 8(16%) patients, threat to vision in 7(14%), infection in 2 (4%) and bleeding in 6(12%) patients. Of the 50 patients, 24(48%) patients required interventions. These interventions included propranolol only in 12(24%) patients, prednisolone only in 4(8%), both propranolol and prednisolone in 5(10%), wound care in 2(4%) and pulse dye laser in 1(2%). Conclusion: The demographics and clinical characteristics of infantile haemangiomas in Malaysia are similar to published reports.