Title:Infantile Hemangioma: An Updated Review
Volume: 17
Issue: 1
Author(s): Alexander K.C. Leung*, Joseph M. Lam, Kin F. Leong and Kam L. Hon
Affiliation:
- Department of Pediatrics, The University of Calgary, Alberta Children’s Hospital, Calgary, Alberta,Canada
Keywords:
Involution, propranolol, corticosteroids, laser, surgical resection, timolol.
Abstract:
Background: Infantile hemangiomas are the most common vascular tumors of infancy,
affecting up to 12% of infants by the first year of life.
Objective: To familiarize physicians with the natural history, clinical manifestations, diagnosis, and
management of infantile hemangiomas.
Methods: A Pubmed search was conducted in November 2019 in Clinical Queries using the key
term "infantile hemangioma". The search strategy included meta-analyses, randomized controlled
trials, clinical trials, observational studies, and reviews published within the past 20 years. Only
papers published in the English literature were included in this review. The information retrieved
from the above search was used in the compilation of the present article.
Results: The majority of infantile hemangiomas are not present at birth. They often appear in the
first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches. Then, they
grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, bosselated,
or with a smooth surface, and sharply demarcated. Deep lesions are bluish and dome-shaped.
Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate
slows down to parallel the growth of the child. Involution typically begins by the time the child is a
year old. Approximately 50% of infantile hemangiomas will show complete involution by the time
a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by 10 to
12 years of age. The majority of infantile hemangiomas require no treatment. Treatment options
include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention
include hemorrhage unresponsive to treatment, impending ulceration in areas where serious
complications might ensue, interference with vital structures, life- or function-threatening complications,
and significant disfigurement.
Conclusion: Treatment should be individualized, depending upon the size, rate of growth, morphology,
number, and location of the lesion (s), existing or potential complications, benefits and
adverse events associated with the treatment, age of the patient, level of parental concern, and the
physician's comfort level with the various treatment options. Currently, oral propranolol is the
treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be
considered for superficial infantile hemangiomas that need to be treated and for complicated infantile
hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.
