Infantile hemangiomas with minimal or arrested growth: A retrospective case series

Abstract

Background/objectives Infantile hemangiomas (IH) with minimal or arrested growth (MAG) constitute a distinctive subset of IH based on their clinical characteristics and natural history. They are often confused with capillary malformations. Methods A retrospective observational study has been carried out in which clinical and perinatal characteristics have been evaluated in all IH‐MAG evaluated in our Dermatology Department in a 5‐year period (January 2013‐December 2017). Results A total of 14 IH‐MAG affecting 13 patients were identified (10 girls and 3 boys). All were born full term, with a mean birth weight of 3448 g for girls vs 3540 g for boys, corresponding to the 72nd percentile for both sexes. The IH‐MAG was noticed at birth in 75% of cases. It had a segmental distribution in 6 cases and focal in 8. The most common clinical features was the presence of an erythematous or reticulated background and superficial red bright papules. Lesions were located preferentially in the lower body. Doppler ultrasound showed no significant vascular abnormalities in any case. Five IH‐MAG developed ulcerations and three required treatment with propranolol. Progressive involution was observed in all cases. Conclusions In spite of being a true IH, the absence of a relationship with prematurity, the high birth weight of the newborns, the predominance on the extremities, the higher percentage of segmental lesions, and their reduced ability to proliferate suggest possible etiopathogenic differences compared with conventional IH.

Infantile Hemangiomas with Minimal and Arrested Growth: Clinical Features and Treatment Outcomes with 0.5% Topical Timolol Maleate

“…Female dominance was somewhat lower than that for classic IHs, where the female: male patient ratio is 3.5:1. One previous study on IH-MAGs reported a sex ratio of 1.8:1, similar to our data; 2 However, another reported a ratio of 3.3:1 9 . In addition, it has been reported that IHs occur frequently in premature infants or those with LBW 8 .…”

“…Although data for interpretation of this result is insufficient, it is possible to find more factors associated with the size difference through future study. Non-proliferative lesions were found more frequently on the lower body, similar to reports from other studies 2 9 . Although this study did not reveal a significant difference in the anatomical location of the lesions of total IH-MAGs, it is worth noting that there was a marked predominance of non-proliferative lesions on the lower body.…”

“…However, we found only one patient (3.2%) with preterm birth and three patients (9.7%) with LBW. The less significant association with prematurity in IH-MAGs was also reported in other series, ranging from 0.0% to 13.0% 2 9 10 . Prematurity or LBW account for a significant number of patients with classic IHs, because the hypoxic environment plays an important role in triggering the development of IHs.…”

“…Although there is a limit to the comprehensive interpretation of cases of IH-MAGs because of the difference in the follow-up periods, one report 11 showed that eight out of nine patients experienced spontaneous resolution with different response rates, while others showed that all lesions persisted without any change in natural progression 13 . Among the treatment options, oral propranolol was mostly used in patients with ulcers or large lesions; although the treatment duration varied, treatment responses were relatively good 9 14 . There was one case report of oral propranolol applied to non-ulcerative IH-MAGs overlying eczema leading to rapid improvement 15 .…”

Transient abdominal telangiectasia of the newborn

“…The lesions we observed are not described in articles concerning cutaneous abnormalities 2 or vascular phenomenon of the newborn. [3][4][5] The bilateral character, absence of vasoconstrictive halo, non-congenital nature, and rapid resolution rule out alternative diagnoses such as infantile hemangiomas with minimal or arrested growth 6 or capillary malformations.…”