Hemangiomas

Infantile hemangiomas (IHs) are nonmalignant growths of vascular endothelial–like cells present in the skin and other organ systems. They are relatively common vascular anomalies seen in approximately 5% to 10% of all infants. Although most IHs are not present at birth, they often develop in the first 2 weeks after birth and tend to grow to their maximum size by 3 to 6 months of age. The physical appearance is that of small, well-demarcated telangiectatic macules or papules. Eighty percent are solitary and may be seen anywhere in the skin but also in the airway, liver, and gastrointestinal tract. The natural history of these lesions is to undergo spontaneous involution at the rate of approximately 10% per year. Approximately 50% of children with untreated hemangiomas have residual changes such as scarring, atrophy, redundant skin, and discoloration.

The management strategy for most patients is “active nonintervention,” given the high incidence of spontaneous involution. This term implies regular follow-up and monitoring for involution, secondary complications, and discussion of the psychosocial impact of living with this condition. Although most patients do well without medical therapy, there are several categories where intervention may be necessary.

One such category consists of hemangiomas in anatomically sensitive areas that lead to secondary complications. This category includes but is not limited to hemangiomas around the eyes (strabismus/amblyopia), the nares (airway compromise and disfigurement), the auditory canals (deafness and disfigurement), the pharynx/larynx (airway compromise), or the liver (congestive heart failure). Another problem is repeated trauma to the hemangioma that leads to bleeding or ulceration. Ulceration affects approximately 20% of IHs, with increased risk if they are large, segmental, and located either …