Management of difficult infantile haemangiomas: Table 1

Abstract

Infantile haemangiomas are common vascular tumours of infancy. They typically present shortly after birth, undergo a period of rapid proliferation, and then slowly involute over many years. Although most patients require no intervention, appropriate investigation and treatment may be necessary in a minority of cases. Identifying which patients require further investigation or intervention can be difficult due to the heterogeneity of clinical presentation. This is compounded by a lack of rigorous randomised controlled trials on haemangioma management. Therefore, the rationale for treatment is not always straightforward. Haemangiomas occur anywhere on the body, have superficial, deep or mixed morphology, and depending on anatomic location, size and subtype, can be associated with underlying structural anomalies and many other potential complications. Generally, the management of difficult haemangiomas is best approached on a case-by-case basis. Over the last few years, there have been several advances in our understanding of haemangiomas, together with some exciting new therapeutic options. In the following review, the authors discuss the various possible complications of infantile haemangiomas, the rationale for treatment and appropriate possible interventions.

The use of propranolol in the management of periocular capillary haemangioma—a systematic review

“…33 Other agents used include vincristine sulphate, cyclophosphamide, imiquimod cream, and interferon. 6,[34][35][36] Intralesional corticosteroids (triamcinolone) are sometimes used. Radiation, laser, 10 embolization, 9 and surgical excision 6,11 are other more invasive options, and the latter might have to be an earlier option in periocular IHs to minimize likelihood of amblyopia.…”

“…6,[34][35][36] Intralesional corticosteroids (triamcinolone) are sometimes used. Radiation, laser, 10 embolization, 9 and surgical excision 6,11 are other more invasive options, and the latter might have to be an earlier option in periocular IHs to minimize likelihood of amblyopia. 6 Propranolol is used by paediatric cardiologists in children as young few weeks to treat tachydysrhythmias, idiopathic hypertrophic subaortic stenosis, paroxysmal hypoxaemic spells, long Q-T syndrome, and congenital heart failure at doses up to 8 mg/kg/day in divided doses.…”

“…This is as a result of astigmatism or mechanical ptosis causing visual deprivation. 5,6 Orbital involvement can lead to proptosis, exposure keratopathy, and compressive optic neuropathy. Although the natural history of an IH is spontaneous regression during the first decade of life, a high proportion of children with periocular IH will need treatment.…”

The psychosocial impact of an infantile haemangioma on children and their parents: Table 1

“…The decision to start treatment in IHs is on an individual basis6 and depends on factors such as location, size and the growth phase of the IH 21. It may be difficult to decide whether or not to treat a visible facial IH that is not life threatening.…”

“…Possible management of IHs includes observation (active non-intervention), local wound care, corticosteroids (topical, intralesional and systemic), other systemic therapies such as vincristine, laser therapy and surgery 5 6. The chance discovery of the effectiveness of propranolol for IHs in 2008 has revolutionised treatment 7.…”