Update on infantile hemangioma

Abstract

The International Society for the Study of Vascular Anomalies classifies vascular anomalies into vascular tumors and vascular malformations. Vascular tumors are neoplasms of endothelial cells, among which infantile hemangiomas (IHs) are the most common, occurring in 5-10% of infants. Glucose transporter-1 protein expression in IHs differs from that of other vascular tumors or vascular malformations. IHs are not present at birth but are usually diagnosed at 1 week to 1 month of age, rapidly proliferate between 1 and 3 months of age, mostly complete proliferation by 5 months of age, and then slowly involute to the adipose or fibrous tissue. Approximately 10% of IH cases require early treatment. The 2019 American Academy of Pediatrics clinical practice guideline for the management of IHs recommends that primary care clinicians frequently monitor infants with IHs, educate the parents about the clinical course, and refer infants with high-risk IH to IH specialists ideally at 1 month of age.High-risk IHs include those with life-threatening complications, functional impairment, ulceration, associated structural anomalies, or disfigurement. In Korea, IHs are usually treated by pediatric hematology-oncologists with the cooperation of pediatric cardiologists, radiologists, dermatologists, and plastic surgeons. Oral propranolol, a non-selective betaadrenergic antagonist, is the first-line treatment for IHs at a dosage of 2-3 mg/kg/day divided into two daily doses maintained for at least 6 months and often continuing until 12 months of age. Topical timolol maleate solution, a topical non-selective beta-blocker, may be used for small superficial type IHs at a dosage of 1-2 drops of 0.5% gel-forming ophthalmic solution applied twice daily. Pulse-dye laser therapy or surgery is useful for the treatment of residual skin changes after IH involution.

Excision of an Ulcerated Scrotal Hemangioma in a Four-Month-Old Boy: A Case Report and Review of Literature

“…Hemangiomas have a distinctive natural history and specific growth characteristics. Most hemangiomas arise in the first few weeks to months of life and pass through a rapid growth phase during infancy followed by involution during the first few years of life [ 1 , 3 - 6 ].…”

“…Routine imaging is not recommended for localized hemangioma. However, when the diagnosis is uncertain, or there is a concern of associated structural abnormalities, magnetic resonance imaging (MRI) and ultrasound evaluation may be considered [ 1 , 3 , 4 , 6 , 7 ].…”

“…Hemangiomas can be classified based on their depth (superficial, deep, and combined), anatomical pattern (focal, segmental, and multifocal) [ 5 ], or risk stratification (high risk and low risk). The latter classification has implications for the timely identification of hemangiomas that may require early intervention [ 1 , 3 , 4 , 6 ].…”

“…High-risk lesions include hemangiomas that may cause permanent scarring and disfigurement, hepatic or airway hemangiomas, and hemangiomas with the potential for functional impairment, ulceration, or associated underlying abnormalities. These hemangiomas should prompt concern, emphasizing increased attention and consideration of early treatment [ 1 , 3 - 6 ]. Ulceration is a common complication of IHs and can result in significant morbidities.…”

Propranolol in the Treatment of Infantile Hemangiomas

“…Due to the involution, most of the IHs need no intervention and only 10% of the patients require medication. 12 Though propranolol is the proper choice for IHs, the adverse events, for example bradycardia and hypoglycemia are noticeable. Other than the medication, surgery and laser management are of great importance.…”