Current Management of Infantile Hemangiomas

Abstract

During the past several years, there have been new advancements in the management of infantile hemangiomas (IHs). In many patients, no treatment is ever necessary--because IHs are well known for their natural history of spontaneous involution. However, a significant minority of hemangiomas do require treatment. Moreover, they are very heterogeneous, making the decision of when, how, and why to intervene quite variable. The least common but most important rationale for intervention is the presence of a life- or function-threatening complication, where prompt therapeutic intervention is a necessity. A much more common scenario is ulceration, where appropriate management is needed to expedite healing and control pain. Increasingly, the life-altering aspects of hemangioma are being recognized as a rationale for treatment because permanent scarring and disfigurement can result even if involution is complete. Treatments for IHs currently include topical, intralesional, and systemic therapies. Laser and surgical modalities are also sometimes used depending on the clinical scenario. In the absence of rigorous evidence-based studies, clinicians must carefully weigh the risks and benefits of medical or surgical treatments versus observation alone in tailoring management to the specific clinical situation at hand.

A case of diaphragmatic infantile hemangioma

“…7 In rare cases accompanied with life-threatening or function-impairment complications, early therapeutic modalities such as excision, systemic medication or vascular embolization are all of choice. 5,10 Embolization has been verified effective for hemangioma, gastrointestinal bleeding, pulmonary sequestration and tumors of infants. 10 For infantile hemangioma, embolization is usually not the first-line therapy, but when medical therapy is not responsive and excision is considered severely traumatic, it will be recommended for suitable patients.…”

“…5,10 Embolization has been verified effective for hemangioma, gastrointestinal bleeding, pulmonary sequestration and tumors of infants. 10 For infantile hemangioma, embolization is usually not the first-line therapy, but when medical therapy is not responsive and excision is considered severely traumatic, it will be recommended for suitable patients. In our case, intervention had a major role in the treatment, and the patient was finally benefited from its minimal invasion and excellent result.…”

Infantile Hemangioma

“…Kortikosteroidler İH tedavisinde yıllardır kullanılan en önemli ajanlardır. Etki mekanizması net olarak bilinmemekle birlikte özellikle İH'lerde hızlı büyüme evresinde etkili olduğu bilinmektedir 27 . Kortikosteroidler intralezyonel veya sistemik olarak uygulanabilir.…”

“…Kortikosteroidler intralezyonel veya sistemik olarak uygulanabilir. Özellikle burun ucu, dudak, periorbital bölge gibi lokalize yerleşimlerde intralezyonel steroid enjeksiyonu (1-2 mg/kg, maksimum 10 mg) kullanılabilir 27 . Ancak özellikle kozmetik açıdan sorun oluşturabilecek lokalizasyondaki bu İH'lerde steroidlerin atrofi yan etkisi göz önünde bulundurulmalıdır.…”

“…Bir çalışmada oral kortikosteroid verilen İH'li hastaların 1/3'ünde regresyon, 1/3'ünde büyümede durma, diğer 1/3'ünde ise yanıt alınamadığı bildirilmiştir 4. Oral kortikosteroid tedavisinin etkili olmasında kritik noktalar doğru dozda kullanılması (2-3 mg/kg/g), tedavinin büyüme evresi boyunca verilmesi ve azaltılarak kesilmesidir. Tedavi süresi ortalama 6 aydır 27 . İnfantil dönemde kullanılan oral kortikosteroid tedavisi sırasında en önemli çekince yan etkileridir.…”