Infantile Hemangioma: An Updated Review

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 telangiectatic or faint red patches. They then 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 which need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.

Tratamento de hemangiomas da região de cabeça e pescoço: revisão integrativa da literatura

“…Ao exame físico, as lesões apresentam-se com coloração avermelhada ou arroxeada, de superfície lisa ou moriforme, e no geral, assintomáticas (Leung et al, 2021). Podem ser utilizadas manobras semiotécnicas, como a diascopia/vitropressão, para diferenciar as lesões vasculares das lesões pigmentadas.…”

“…No tocante ao tratamento dos hemangiomas, devem ser levados em consideração alguns fatores, como a idade do paciente, localização, tamanho, estágio evolutivo e a natureza, arterial ou venosa, da lesão (Pitta & Gomes, 2009;Leung, Lam, Leong & Hon, 2021). A maioria dos hemangiomas infantis não necessita ser tratado e, geralmente, esse tratamento se faz necessário quando há complicações (Leung et al, 2021). No geral, a terapêutica direcionada aos hemangiomas é classificada em duas categorias, local e sistêmica (Atas et al, 2018).…”

Versatile Vessel-on-a-Chip Platform for Studying Key Features of Blood Vascular Tumors

“…Vascular tumors formed from blood (e.g., hemangioma) or lymph (e.g., lymphangiomas) vessels can be either benign or malignant [12]. The former is the most common benign tumors of infancy that appears early after birth (4-5% prevalence).…”

Infantile haemangioma presenting in combination with a cerebriform naevus sebaceous on the scalp

“…IH is one of the most common benign vascular birthmarks with a predilection for female sex, multiple gestation, preterm, low birth weight, progesterone use, older maternal age, in vitro fertilization and white racial background 1–3 …”

“…A well‐defined erythematous lesion is described for the superficial subtype, whereas a bluish dome‐shaped lesion is typical for the deep subtype, and mixed type is a combination of the superficial and deep subtypes 1,2 . IH can be differentiated from congenital haemangioma (CH) by GLUT‐1 immunostaining, which is typically positive in the majority of IH cases, whereas CH, present at birth by definition, is almost always GLUT‐1‐negative 2,3 . Oral β‐blockers are considered the mainstay of treatment for IH that require treatment 1–3 …”