Natural history of periocular capillary haemangiomas: changes in internal blood velocity and lesion volume

The Effect of Intralesional Steroid Injections on the Volume and Blood Flow in Periocular Capillary Haemangiomas

“…The growth phase is mainly due to a rapid division of immature, incompletely differentiated vascular endothelium (Dadras et al, 2004)-possibly influenced by abnormal mast cell proliferation (Glowacki et al, 1982)-and of supporting pericytes which continue to proliferate after birth; involution results in residual fibro-fatty tissue, with recent work suggesting that mesenchymal stem cells persist within the haemangioma and later form adipocytes (Yu et al, 2006). Despite the frequent reference within the literature to a 'proliferative' and an 'involutional' phase, both the current study and earlier work from our group (Verity et al, 2006) suggest that the two processes probably occur simultaneously. An early rise in both lesion volume and internal blood flow appears to be followed by a cyclical decline around an exponential mean.…”

“…Nine children were treated, 8 with steroid injections alone (Cases 1-8) and one with both steroids and surgical resection (Case 9) ( Table 1) and 8/9 children receiving steroids were female-a proportion very different to the equal sex distribution in 24 children without treatment (Verity et al, 2006) (p = 0.046) ( Table 2). Infants requiring steroids presented at a significantly younger age (all within 1 month of birth), as compared to those in the untreated series who presented at an average age of 2.1 months (range 0-14) (p = 0.04); moreover, follow-up prior to returning to the referring ophthalmologist was longer in the treated group (mean 65 months; range 26-105) than in the untreated children (mean 35 months; range 4-92) (p = 0.002) ( Table 2).…”

“…Methods for ultrasonographic assessment of size and blood flow, and techniques for data analysis, were as described previously (Verity et al, 2006). Where appropriate, comparison was made with the results for this latter series of 24 children-in whom medical intervention was not indicated.…”

“…Although diagnostic confirmation often rests on Doppler ultrasonography-identifying the characteristic high internal reflectivity and internal blood velocities-no longitudinal study of the effect of steroid therapy has been published: this study reports the response of both haemangioma volume and blood velocity to local steroid therapy, and compares it with the natural history of capillary haemangiomas (Verity et al, 2006).…”

OCT imaging of skin cancer and other dermatological diseases

“…Previous studies demonstrated a 3D OCT image of a similar lesion [57] and in another study OCT images matched histology of haemangiomas [58]. The use of Doppler OCT may have a potential for identifying feeding vessels and prognosis estimation in capillary haemangiomas and vessels in general during laser treatment, which has been demonstrated using Doppler US [59], and in a study of one port-wine stain by Doppler OCT [60].…”