ulcerated lesion on diaper area - suggestions welcome (ok desperately sought) - Vascular Birthmarks Foundation Forum
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  #1  
Old 05-04-2010, 06:45 AM
Kirstyloo Kirstyloo is offline
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Unhappy ulcerated lesion on diaper area - suggestions welcome (ok desperately sought)

My 9-month-old daughter has a half dollar sized hemangioma on her right buttocks. This hemangioma like the other 3 on her body has started to regress. We have always treated it with A&D cream to keep it moist and protected. Two weeks ago, she had a stomach bug and horrible diarrhea.
10 days ago, hemangioma developed a small, infected lesion the size of pencil erasure. We took her to her ped within 24 hours and we were given an antibiotic cream to put on it. The infection seems to have resolved; however, the lesion became ulcerated.

The lesion is about the size of nickel and about 3 mm deep. On day 6, we were sent to our cityís childrenís hospital and a plastic surgeon where she was given a laser treatment. She will likely have another one in 5 weeks. When we commented that the lesion caused significant pain, we were given lidocaine jelly. When we asked them how to dress the wound, they recommended simply using a nonstick pad without tape. While that might work for other sores, we have real trouble keeping the area clean and dry. Her lesion is covered with stool 3-4 times per day, and it is perpetually wet. We try to change her diaper every 2 hours and immediately after stool. Even during the day, we canít keep her sore clean. To make matters worse, she usually starts crying when we start to change her diaper.

Weíve started trying to give her a short bath each night and then let her sore dry in the air for 20-50 minutes. Any suggestions about how to better protect or dress this sore would be greatly appreciated.

The laser treatment seemed to decrease her pain, but it doesnít seem to have prompted healing of the wound or maybe Iím expecting this to resolve more quickly. What is a reasonable time frame?
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Old 05-04-2010, 05:15 PM
mkrzarmomma2 mkrzarmomma2 is offline
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My daughter currently has an ulcerated hemi on her neck. It also is impossible to keep clean because of baby food, formula, drool, etc. We were given gentimicin to cover to complete area to help protect and was also tolden a non-stick pad and tape. My dd is having hers removed by surgery because they said the ulceration will most likely never heal in that spot. Have you been given the option of surgery?
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Old 05-05-2010, 01:11 AM
nickbar nickbar is offline
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I am glad to hear you are having laser tx. done to heal this ulceration. My only advice is to put a heavy amount of zinc oxide type product on the area and continue the changing frequently. I would also looking for gortex material pads, they don't stick and pull skin.

I am hoping for relief soon for your baby girl!!!
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Old 05-05-2010, 01:41 PM
Kirstyloo Kirstyloo is offline
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No, surgery wasn't mentioned. When we had the laser treatment, they indicated that the lesion should start getting better shortly. It might look worse (bruise marks inside), but that the pain and lesion should start to get smaller. It actually looks a bit bigger 5 days later and it has redness on the side of the birthmark.

When I look at the surface of the ulcer, I see a whitish, shiny material. Iím guessing it is either clotted plasma from the leaking wound or a thin layer of pus. It seems to me that the site needs to be cleaned out to promote healing; however, weíre not in a position to do it effectively or painlessly.

We donít have another appointment with the plastic surgeon for 4 more weeks. We were supposed to see him in 3 based on his typical treatment; however, he is on vacation over Memorial Day weekend.

Iím scared by the estimates that this will take 1-6 months to heal and that she will ultimately need surgery to remove the resulting scar. Weíve been on vacation this week. Iím not sure how daycare will handle this. Iím even more concerned because Emily is moving up to infant II when we get back on Friday.


I think I will call her ped today to see if she could make any additional suggestions. Personally, I think that she should see someone who specializes in wound management who will order wound some type of wound cleaning and packing routine.

Iíve told my husband that Iím going to be a witchy, demanding and pushy mother.

Thanks for your comments!

Last edited by Kirstyloo : 05-05-2010 at 01:42 PM. Reason: I missed part of my reply.
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Old 05-05-2010, 06:00 PM
mrssuperspy mrssuperspy is offline
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I know there are differing opinions on this, but Aquaphor worked wonders for my daughter's ulcerated hemangioma. The docs were saying just Vaseling, but my Mom googled and suggested we try the Aquaphor. The ulcer was healed within 2-3 days. It had been there for weeks with the Vaseline. I strongly believe in it. Plus, in the diaper area I would think it would protect the hemangioma from wetness also. Good luck to you and your sweet baby!
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Old 05-17-2010, 10:31 PM
Kirstyloo Kirstyloo is offline
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Well, I'm happy to report that my DD's ulcer is getting smaller! It is about 1/3 of the size than it was when I last posted.

Here is what we tried. I'm only including it here becasue we were frustrated that the doctors didnít give us a wound management plan. We took what little advice we got from our Ped and the Plastic surgeon and here is what we came up with:
1. Change diaper very 2 hours religiously while awake and change her diaper ASAP after stool. She is 9 months old so we could let her sleep on her stomach during the night so the pee would drain forward. If she were younger, you need to balance these issues with the issue of potential SIDS.
2. We got different diaper wipes. We found some without alcohol for general diaper cleaning. Weíve also been using a clean wet wash cloth to clean the wound. We send a pack of 4-6 wet wash cloths to day care in a ziplock with the instruction to dab/pat her ulcer at each diaper change. They use the wipes for all other areas.
3. Our plastic surgeon gave us a prescription for Lidocaine. We apply a very thin amount of Lidocaine 2% to the sore after diaper changes. Within 2-5 minutes, it appears to dramatically decrease her pain; however, you need to be very careful not use too much as it can cause respiratory and cardiac problems. Our plastic surgeon didnít mention this when it was prescribed. Only when I called back a week later and talked to his nurse was informed of the drugs risks.
4. We applied an antibiotic cream 3x day and after stool. From what Iíve read, antibiotic cream can irritate the sore.
5. Our Ped indicated that we could use Aquafor to provide a water barrier; however, it didnít stay there well enough between diaper changes. When I asked the Plastic Surgeon how to keep the area clean, he recommended using a nonstick pad without tape. Each in isolation wasnít working as they didnít last or stay stuck so we combined them.
6. We applied a diaper ointment with zinc oxide to the rest of the diaper area. Because our DD would cry so hard at each diaper change, we realized that we weren't as good about taking care of the "other" areas. So this became an other priority.
7. We let her sit in a warm bath for 5-10 minutes each day.
8. We let her ďair dryĒ bottom up for 10-40 minutes each day on dry towels.

I think that the key for us was the Aquafor and the pad. It did a pretty good job of keeping stool and urine off of her sore. Even without the tape, the Aquafor did a pretty good job of holding the pad in place.

Iím so happy to say that my daughterís ulcer is much smaller, and it is also great that she no longer cries when we change her diaper. I hope that it continues that way.
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Old 05-17-2010, 10:35 PM
missy missy is offline
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Wonderful!! I'm glad to hear good news!!

You still have the appointment in four weeks? I hope the ulcer is completely healed by then... it sounds like it might be.

Missy
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Old 05-17-2010, 11:19 PM
Kirstyloo Kirstyloo is offline
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Yes, we still have an appointment for about 3 1/2 weeks from now. I'm guessing that they will do another laser treatment as the birth mark is still clearly visible. It ulcerated during involution.

This time I will bring the lidocaine jelly with us, and I will apply right after the treatment to provide her with some relief. I have no idea why they didn't put it on after the first treatment. She cried so hard until she eventually fell asleep. I've never seen her so upset. It took me over an hour to get the med as I couldn't get the lidocaine jelly at the first pharmacy that I tried.

Last edited by Kirstyloo : 05-17-2010 at 11:20 PM. Reason: correction
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Old 05-18-2010, 11:22 AM
missy missy is offline
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I think you have to go to a compounding pharmacy to get lidocaine jelly. At least, that was how it used to be (so many things are different now).

Let us know how the appointment goes!! Perhaps the treatment won't be so bad this time, since things seem to be healing.

Missy
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Old 05-18-2010, 04:22 PM
lizzyh lizzyh is offline
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Kirstyloo, reading your original post made me want to cry. I know what you're going through and how hard it is to see your baby in pain. My daughter has a hemangioma on her left buttcheek that ulcerated at about 3 months. The ulcer was present for about 3 months and was bad for 2 months. She received laser treatment which seemed to help heal the ulcer. Have you head of mepilex borders? They are awesome bandages that stick to the bottom and are waterproof. They completely protect from poop and pee and promote wound healing. I think you need a dr's order and can get them through a medical supply company. Check with your dr and insurance to see if they'll cover them. We are still using them to cover the healed ulcer. We used sterile wound wash and vaseline on the mepilex. This was helpful for other care providers rather than wiping the ulcer. We had some luck with non stick pads cut to size and taped on with J&J paper tape, but this did need changed much more than the mepilex.
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