Clinical Challenge: Plaque on the Belly Button - MPR

Clinical Challenge: Plaque on the Belly Button

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A 3-month-old Hispanic baby is brought to the office for evaluation of a persistent “sore” on her belly button. The sore emerged shortly after the umbilical stump fell off, and occasionally drains a clear fluid. Examination reveals a firm, erythematous, well-circumscribed plaque. Prior evaluation by a pediatrician detected no systemic abnormality.

Umbilical granuloma is one the most common anomalies seen in the umbilicus of neonates. Lesions develop within the first few weeks of life shortly after the umbilical cord separation. Umbilical granulomas are vascular, firm plaques that can measure from 1...

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Umbilical granuloma is one the most common anomalies seen in the umbilicus of neonates. Lesions develop within the first few weeks of life shortly after the umbilical cord separation. Umbilical granulomas are vascular, firm plaques that can measure from 1 to 10 mm and are occasionally accompanied by serosanguineous discharge.1 Differential diagnosis includes umbilical polyp and umbilical urachus.2

Resolution of the lesion has been reported following treatment with both silver nitrate and topical corticosteroids (for example, clobetasol proprionate).3,4 Silver nitrate is applied weekly by the provider until the lesion is completely resolved. It is important to prepare the perilesional skin with petroleum jelly to protect against burns. Topical corticosteroids are applied twice per day at home. The time to lesion resolution is similar with both treatments. Weekly follow-up is prudent to monitor the treatment site for infection.

Rebecca Geiger, PA-C, is a physician assistant on staff at the DermDox Center for Dermatology in Sugarloaf, Pennsylvania. Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, associate professor of medicine at Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References


1. Das A. Umbilical lesions: a cluster of known unknowns and unknown unknownsCureus. 2019;11(8):e5309.  

2. Minkes RK. Disorders of the umbilicus. Medscape website.  https://emedicine.medscape.com/article/935618-overview. Updated Aug 30, 2018. Accessed January 29, 2020.

3. Brødsgaard A, Nielsen T, Mølgaard U, Pryds O, Pedersen P. Treating umbilical granuloma with topical clobetasol propionate cream at home is as effective as treating it with topical silver nitrate in the clinicActa Paediatr. 2015;104(2):174-177.

4. Ogawa C, Sato Y, Suzuki C, et al. Treatment with silver nitrate versus topical steroid treatment for umbilical granuloma: a non-inferiority randomized control trialPLoS One. 2018;13(2):e0192688.