Incidence and clinical factors associated with ulceration in infantile hemangiomas

Faith, Esteban Fernández; Shah, Sonal D.; Braun, Mitchell; Pope, Elena; Lara‐Corrales, Irene; Witman, Patricia M.; Harfmann, Katya; Bradley, Flora; Keesari, Rohali; Jackson, K. A.; Hallagan, Alexandra; Frieden, Ilona J.

doi:10.1016/j.jaad.2022.10.047

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…Despite evidence that β-blocker therapy can decrease the frequency and severity of ulceration, IH ulceration continues to be a complication and management challenge in a substantial minority of patients. [3][4][5][6] Our study aim was to characterize IH ulceration in a large cohort during the "β-blocker era," including characteristics of IH ulceration, treatment interventions, and healing times.…”

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confidence: 99%

Clinical Features, Prognostic Factors, and Treatment Interventions for Ulceration in Patients With Infantile Hemangioma

et al. 2021

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IMPORTANCEUlceration is a common complication of infantile hemangioma (IH), which leads to substantial morbidity. Ulceration in IH has not been systematically studied since the advent of β-blocker therapy for IH. OBJECTIVESTo examine treatment interventions used for ulceration in IH and identify clinical prognostic indicators of healing time. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter cohort study was conducted on 436 consecutive patients with a clinical diagnosis of ulcerated IH and available clinical photographs. Patients receiving care at tertiary referral centers evaluated between 2012 and 2016 were included; statistical and data analysis were performed from February 7 to April 27, 2020. EXPOSURES Clinical characteristics, treatment interventions, course, complications, and resource use were analyzed. Treatment interventions for ulceration in IH included local (wound care, topical), systemic (β-blocker, corticosteroids), and procedural (pulsed-dye laser). MAIN OUTCOMES AND MEASURES The primary end point was time to complete or nearly complete ulceration healing. Clinical characteristics were analyzed to determine the responses to most common interventions and prognostic factors for healing of ulceration. RESULTSOf the 436 patients included in the study, 327 were girls (75.0%); median age at ulceration was 13.7 weeks (interquartile range, 8.86-21.30 weeks). The median heal time was 4.79 weeks (95% CI, 3.71-5.86 weeks) with wound care alone, 5.14 weeks (95% CI, 4.57-6.00 weeks) with timolol, 6.36 weeks (95% CI, 5.57-8.00 weeks) with a systemic β-blocker, and 7.71 weeks (95% CI, 6.71-10.14 weeks) with multimodal therapy. After adjusting for IH size, a dose of propranolol less than or equal to 1 mg/kg/d was associated with shorter healing time compared with higher propranolol doses (hazard ratio, 2.04; 95% CI, 1.11 to 3.73; P = .02). Size of the IH was identified as a significant prognostic factor for healing time in multivariable analysis. Increasing size of IH portends a proportionately longer time to heal of the ulceration.CONCLUSIONS AND RELEVANCE Despite the use of β-blockers, this cohort study found that a subset of patients with IH ulceration continued to experience prolonged IH healing times. Larger IH size appears to be a poor prognostic factor for time to heal. For patients requiring systemic therapy, initiation of propranolol at lower doses (Յ1 mg/kg/d) should be considered.

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confidence: 99%

Clinical Features, Prognostic Factors, and Treatment Interventions for Ulceration in Patients With Infantile Hemangioma

et al. 2021

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“…Consequently, hormone and estrogen receptor inhibitors have been recommended as potential treatment options for hemangiomas [ 76 , 77 ]. Ulceration is a common complication mainly occurring in the proliferating phase in the above, lower lip, and perineal parts [ 78 ]. Additionally, complications include visual compromise, bleeding, airway obstruction, auditory canal obstruction, cardiac compromise, etc.…”

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confidence: 99%

Global research trends of infantile hemangioma: A bibliometric and visualization analysis from 2000 to 2022

Lin,

Cai,

Shan

et al. 2023

Heliyon

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“…1 Moreover, ulceration, bleeding, infection, and other complications greatly affected children's quality of life, physical development, and interactive anxiety. 1,5 According to an international observational cross-sectional study, over 70% of families with children are affected by IH, with approximately half of the parents expressing concerns about how their children's IH impacts their professional lives. 6 Therefore, comprehensive, and detailed research on IH is necessary, for which our understanding of IH is segmentary.…”

Section: Introductionmentioning

confidence: 99%

“…However, 70% of untreated patients suffered from residual consequences such as telangiectasia and excessive fibrofatty accumulation 1 . Moreover, ulceration, bleeding, infection, and other complications greatly affected children's quality of life, physical development, and interactive anxiety 1,5 . According to an international observational cross‐sectional study, over 70% of families with children are affected by IH, with approximately half of the parents expressing concerns about how their children's IH impacts their professional lives 6 .…”

Section: Introductionmentioning

confidence: 99%

The prevalence, complications, and risk factors for infantile hemangioma: a systematic review and meta‐analysis

Sun,

Zhao,

Meng

et al. 2024

Int J Dermatology

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The epidemiological landscape of infantile hemangioma (IH) has been extensively explored through diverse data sources; however, a scarcity of systematically pooled and quantified evidence from comprehensive global studies persists. In this meta‐analysis, we systematically review available literature to elucidate the prevalence, distribution of lesions, complications, and risk factors associated with IH. A meticulous search encompassing the Cochrane Library, PubMed, Embase, and Web of Science identified 3206 records, of which 55 studies met the inclusion criteria. We found that the overall prevalence of IH is 2.8% [95% confidence interval (CI): 1.5–4.4%] (31,274,396 infants), and IH was located more frequently in the head and neck with a prevalence of 47.4% (95% CI: 39.5–55.4%). The overall prevalence of complications of IH is 24.3% (95% CI: 18.6–30.5%), ulceration is 16.0% (95% CI: 10.4–21.2%), bleeding is 5.6% (95% CI: 3.3–8.5%), visual impairment is 5.6% (95% CI: 3.0–8.9%), infection is 2.8% (95% CI: 1.5–4.8%), subglottic obstruction is 1.5% (95% CI: 0.5–3.0%), respectively. Through 27 studies, we have evaluated 35 factors encompassing perinatal factors, socioeconomic factors, maternal complications, drug factors, and antepartum procedures, and identified 18 risk factors that increase the prevalence of IH. These findings can greatly assist clinicians and family members in effectively evaluating the risk of IH, and determining whether pregnant women should undergo intensified monitoring or preventive measures.

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Incidence and clinical factors associated with ulceration in infantile hemangiomas

Cited by 7 publications

References 12 publications

Clinical Features, Prognostic Factors, and Treatment Interventions for Ulceration in Patients With Infantile Hemangioma

Clinical Features, Prognostic Factors, and Treatment Interventions for Ulceration in Patients With Infantile Hemangioma

Global research trends of infantile hemangioma: A bibliometric and visualization analysis from 2000 to 2022

The prevalence, complications, and risk factors for infantile hemangioma: a systematic review and meta‐analysis

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