Infantile hemangiomas: risk factors for complications, recurrence and unaesthetic sequelae

Abstract

Background Infantile hemangiomas (IH) occur in approximately 4% to 10% of the pediatric population. The identification of clinical subtypes and conditions that indicate increased risk for complications is essential for therapeutic success. Objectives To identify risk factors for complications, recurrence and unaesthetic sequelae. Methods Retrospective cohort of patients with infantile hemangiomas undergoing follow-up at the Dermatology Service of Universidade Federal de Ciências da Saúde de Porto Alegre, between 2006 and 2018. Results 190 patients were included; 24% had some type of complication, ulceration being the most frequent, and 86% required treatment. On correlation, ulceration was statistically related to mixed IH ( p = 0.004), segmental IH ( p < 0.01) and location in the gluteal region (p = 0.001). The mean time of treatment with propranolol was 12.7 months. Patients with PHACES syndrome and segmental infantile hemangioma required longer treatment (p < 0.001 and p = 0.0407, respectively), as well as those who started treatment after five months of life (p < 0.0001). Recurrence occurred in 16.6% of the treated patients, all-female; 94% were located on the head and neck (mainly on the upper eyelid, cyrano, S3 segment, and with parotid involvement); 61% and 38.8% were of the mixed and deep subtypes, respectively. Approximately 1/3 of the patients had some unaesthetic sequelae. Study limitations As this is a retrospective study, data and photos of some patients were lost. Conclusions Mixed and segmental hemangiomas are risk factors for ulceration and sequelae. Recurrence occurs more often in females and segmental hemangiomas. Segmental infantile hemangioma and PHACES syndrome require a longer time of treatment. Specific protocols are required for infantile hemangiomas with a high risk of recurrence.

The prevalence, complications, and risk factors for infantile hemangioma: a systematic review and meta‐analysis

“…27 studies 7–9,27–50 investigated prevalence, mainly in America, Germany, Canada, Israel, Japan, Australia, Netherlands, Denmark, China, Mali, and Brazil. 27 studies 7,12,28,35–37,44,45,47,50–67 reported the distribution of IH lesions, and 14 studies 7,12,35,50–52,55,57,59,61,63,64,68,69 surveyed the occurrence of complications. Specifically, 28 studies 7,9,16,30–34,36,40,41,44,46–48,52,53,55,62,63,65,67,70–75 focused on the risk factors of IH.…”

“…27 studies [7][8][9] investigated prevalence, mainly in America, Germany, Canada, Israel, Japan, Australia, Netherlands, Denmark, China, Mali, and Brazil. 27 studies 7,12,28,[35][36][37]44,45,47,[50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] reported the distribution of IH lesions, and 14 studies 7,12,35,[50][51][52]55,57,59,61,63,64,68,69 surveyed the occurrence of complications. Specifically, 28 studies 7,9,16,[30][31][32]…”

Infantile Hemangiomas of the Head and Neck: A Single-Center Experience

“…Complications developed in 35% of patients with head and neck IHs. With the introduction of propranolol as the first-line therapy after 2008, initiating treatment has become more frequent, and the complication rate may have decreased [ 12 , 13 , 14 , 15 , 16 , 17 ]. Before the serendipitous discovery of propranolol [ 13 ], steroids had an important place in the treatment of IHs, particularly in difficult and complicated cases.…”

Knowledge of community pharmacists on infantile haemangioma: Gaps and lack confidence to deliver propranolol still need to be filled

“…IH is usually not present at birth and is characterised by a rapid proliferation of endothelial cells and vascular channels in the first days or first weeks of life. A precursor lesion such as telangiectatic erythema or anaemic skin may be visible at birth 3 . The diagnosis is usually made during the clinical examination.…”

“…A precursor lesion such as telangiectatic erythema or anaemic skin may be visible at birth. 3 The diagnosis is usually made during the clinical examination. It can be classified according to the depth of skin involvement, such as superficial, deep or mixed, and the morphologic aspect, such as focal, multifocal or segmental.…”