Infantile Hemangiomas: An Update on Pathogenesis and Treatment

Abstract

Infantile hemangiomas are the most common benign vascular tumors in infancy. This review includes an update on the current knowledge on pathogenesis, a discussion on indications for treatment, and a review of the mechanisms underlying the different treatment methods. Although most infantile hemangiomas require only active observation because of their natural course, which results in involution, about 10% present with complications that require immediate treatment. The basic treatment includes systemic and topical options. In cases of insufficient response or rebound growth, other forms of treatment should be considered. In some cases, combined therapy might be initiated.

Early Presentation of an Ulcerated Infantile Haemangioma in a Newborn

“…Infantile haemangiomas (IHs) are the most common non-malignant vascular type of tumours in paediatric age affecting up to 5%-10% of infants in the first years of life [1,2]. The underlying etiopathogenetic factors for IHs formation are not yet fully understood.…”

“…However, it is observed in clinical practice and international reviews also describe a predilection for their occurrence in female Caucasians. Other risk factors were proposed such as low birth weight, prematurity, advanced maternal age, multiple gestations, in-vitro fertilisation, pre-eclampsia, and placental malformations [1][2][3].…”

“…The proliferation period typically starts in the first weeks of life and continues up to the 6-12 months of age and it is characterised by rapid growth of the lesion. The involution phase takes place afterwards and it is determined by the cessation of the lesion's growth with stabilisation in its size, followed by a progressive resolution of the initial vascular lesion in the following years, with or without direct intervention [1,2,4]. Partial or complete resolution of IHs is observed in 80%-90% of the cases in the first decade of life without any functional or cosmetic sequelae [1,2,4].…”

“…The involution phase takes place afterwards and it is determined by the cessation of the lesion's growth with stabilisation in its size, followed by a progressive resolution of the initial vascular lesion in the following years, with or without direct intervention [1,2,4]. Partial or complete resolution of IHs is observed in 80%-90% of the cases in the first decade of life without any functional or cosmetic sequelae [1,2,4]. However, after the involution phase occurs, residual scarring, telangiectasia or local skin atrophy can occur in some cases and complete resolution appears to be dependent on the early onset of their involution phase [3].…”

“…The diagnosis of IHs is clinical and is based on the history of the lesion's evolution and clinical examination. However, imaging may be needed to reach a diagnosis in certain cases [1][2][3][4][5][6]. As previously mentioned, most uncomplicated IHs evolve in a benign way with no need for direct intervention; therefore, conservative management with ambulatory follow-up of the lesion is the most common strategy employed.…”