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Natural involution remains a viable treatment option for the majority of patients with uncomplicated hemangiomas. Excisional surgery, laser, and pharmacologic remedies are indicated for a subset of complicated hemangioma patients.

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Hemangiomas are a group of pediatric tumors that present at or soon after birth. Rapid proliferation is seen in the neonatal period, and may continue for the first year of life. Involution follows, and may last as long as 12 years. Since hemangiomas invariably involute, the vast majority have been left untreated. At least 10% to 20% of cases, however, will need active intervention, traditionally in the form of oral Prednisone. The frequent occurrence of life-threatening complications, permanent deformities, and irreversible psychosocial damage in spite of adequate steroid therapy necessitated a fresh look at the management of these lesions. Using recently developed laser technology alone or in combination with surgical excision, the authors have developed guidelines for safe intervention in all stages of the hemangioma cycle. Safe, active intervention in accordance with these guidelines offers an alternative to the more conservative approach previously advocated.

Acne keloidalis is a chronic scarring folliculitis located on the posterior neck of young black men. It is manifest clinically by follicular papules that coalesce into firm plaques and nodules. Examination of early lesions shows that inflammation begins at the deep infundibular and isthmic levels of the hair follicle and is accompanied by absence of sebaceous glands. The etiology of acne keloidalis is uncertain, but centers around anatomic, infectious, and autoimmune theories. Successful surgical therapy of advanced cases can be carried out using a number of methods as long as subfollicular destruction of the process is achieved.