IH usually forms within the first week after birth and grows rapidly during the first 3–6 months, known as the proliferating phase of IH. Subsequently, spontaneous regression occurs from 12 months to 5 years of age and beyond [5,6,7]. IH may require intervention owing to serious cosmetic and functional problems. Propranolol is regarded as the first-line treatment for IH. However, the treatment with oral propranolol requires monitoring the blood pressure and heart rate in the first 3 days, leading to low compliance of outpatients. This therapy has not reached significant results in about 10% of patients, as a result of regrowth, slow improvement, or failure [8, 9]. ICZ has been used as a safe clinical agent to treat broad-spectrum fungal infections more than 30 years [10]. Researchers have studied the mechanism of its inhibition of angiogenesis [11, 12]. In 2015, the effect of ICZ capsule on IH was suddenly discovered by our team, resulting in better clinical outcomes in six cases [4]. We found that ICZ induces regression of infantile IH via downregulation of the platelet-derived growth factor-D/PI3K/Akt/mTOR pathway [13].

In our case, the patient’s parents had a strong desire for treatment. After an ineffective treatment outcome with topical application of timolol maleate eye drops for nearly 3 months, he was brought to our hospital. After 1 month, the lesion achieved partial efficacy and almost resolved with remaining skin erythema after nearly 4 months of treatment with ICZ oral solution. Hepatic and renal function remained normal, with only mild diarrhea during the course of oral medication. The infant may be in the proliferative period during treatment with ICZ. Clinical images showed dramatic improvement following ICZ therapy, which is unlikely due to spontaneous resolution alone. It is convenient to examine liver function before and after treatment with ICZ. Infants may have difficulty swallowing capsules. Furthermore, adjusting the dosages of capsules for children can prove troublesome. One milliliter of ICZ oral solution contains 10 mg of ICZ, which is more accurately measured on the syringe and more convenient than splitting capsule particles. In addition, its cherry flavor makes it more acceptable to infants. Treatment compliance of oral ICZ in infants has been reported to be good. Neither this boy in this case nor the infants in the previous case series reported by our team currently show recurrence of hemangioma. Due to limited data, more clinical trials are needed to be conducted for confirmation. Oral ICZ can be used as a supplementary treatment for IH.

Compared with the naked eye, dermoscopy can observe subtle changes before and after treatment more clearly by adjusting the magnification. At present, there are only a few reports about the dermoscopic characteristics of IH. Meanwhile, MRI can provide additional information, such as the extent of the lesion. Several studies have reported on the imaging features of IH on conventional MRI [14, 15].