Clinical Practice Guideline for the Management of Infantile Hemangiomas

Abstract

Infantile hemangiomas (IHs) occur in as many as 5% of infants, making them the most common benign tumor of infancy. Most IHs are small, innocuous, self-resolving, and require no treatment. However, because of their size or location, a significant minority of IHs are potentially problematic. These include IHs that may cause permanent scarring and disfigurement (eg, facial IHs), hepatic or airway IHs, and IHs with the potential for functional impairment (eg, periorbital IHs), ulceration (that may cause pain or scarring), and associated underlying abnormalities (eg, intracranial and aortic arch vascular abnormalities accompanying a large facial IH). This clinical practice guideline for the management of IHs emphasizes several key concepts. It defines those IHs that are potentially higher risk and should prompt concern, and emphasizes increased vigilance, consideration of active treatment and, when appropriate, specialty consultation. It discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 months of age in most cases. Because many IHs leave behind permanent skin changes, there is a window of opportunity to treat higher-risk IHs and optimize outcomes. Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs. When systemic treatment is indicated, propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day. Treatment typically is continued for at least 6 months and often is maintained until 12 months of age (occasionally longer). Topical timolol may be used to treat select small, thin, superficial IHs. Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs.

Kaposiform hemangioendothelioma: current knowledge and future perspectives

“…MRI is helpful in differentiating the difficult cases. Throughout the development of IHs, ECs in IH lesions are positive for Glut-1, which is absent in KHE and other vascular tumors [87,88].…”

Management of infantile hemangiomas during the COVID pandemic

“…The use of beta-blockers in the treatment of IH has revolutionized care, and recent American Academy of Pediatrics (AAP) clinical practice guidelines (CPG) emphasize that early therapeutic intervention is critical for complicated IH to prevent medical complications or permanent disfigurement. 1 In this statement, we review FDA/EMA-approved monitoring guidelines, information derived from several clinical practice guidelines, and other publications regarding initiation and monitoring of beta-blocker therapy, including newly published information which could help inform modification of these practices. We give recommendations to help guide decisions about when telehealth may be an alternative to in-office visits, including initiation, dosage changes, and continued evaluation for those patients requiring treatment.…”

Superficial Genital Infantile Hemangiomas

“…According to the depth of the affected tissue, IHs are classified as superficial (localized primarily on the surface of the skin), deep (within the deep dermis and subcutaneous tissue) or mixed -superficial and deep, also known as combined IHs (1,5). All the presented infants had the superficial type of IHs.…”

“…Infantile hemangiomas (IHs) are the most frequent vascular tumors of infancy. The estimated incidence reported in the literature ranges from 4% to 5% during the first year of life (1)(2)(3).…”

“…The vast majority of IHs are benign, with no need for intervention (1,2). However, substantial subset of IHs can be the cause of a variety of medical, functional and/or aesthetic adverse effects, which depends on the size and clinical characteristics of IH as well as its localization.…”