Influence of Age and Morphological Features on the Clinical Manifestations and Treatment Efficacy of Hemangiomas in Children

Abstract

Background. Infantile hemangioma (IH) is a neoplasm that is most common in childhood. Morphologically, hemangiomas are divided into superficial, deep and mixed, focal, segmental, indeterminate and multifocal. The course of IH includes phases of rapid growth followed by slow involution. The degree of involution of hemangioma is variable. Hemangiomas can lead to the appearance of permanent deformities of soft tissues or functional disorders, especially when localized on the face and vital structures. Clinical heterogeneity of hemangiomas creates significant difficulties for physicians in resolving issues of treatment tactics. Specific characteristics of the clinical behavior of hemangiomas of various morphological types can be crucial in the choice of management tactics for such patients. Objectives. The aim of the work is to study the effect of different morphological types of hemangioma in children on the effectiveness of treatment of age-related clinical features. Subjects and Methods. The study group consisted of 100 children in age from birth to 6 years who have hemangiomas of different morphological types and localizations and did not receive previous treatment. All research participants for hemangioma severity scale (HSS), hemangioma activity scale (HAS), visual analogue scale (VAS) before, during and after treatment were scored. Serum levels sFas/sFasLs before and during treatment evaluated. Results. With increasing the child’s age, the indicator as for HAS reliably decreases for all types of hemangiomas. In all types of hemangiomas predominantly an active growth took place. An abortive growth in 10% of patients was noted. For focal hemangiomas, the indicator of sFas decreases with age, and for multifocal hemangiomas it increases. In both cases, there is an increase in the sFasL indicator with increasing age of the child. In our study, in age group before 1 year in the factor structures, “age” factor was considered to be the main one and manifested by a decrease in the activity of hemangioma with an increase in the age of the child. Among children over 1 year age, during the course of treatment, the greatest contribution the “hemangioma severity factor”, the influence of which leads to a decrease in the cosmetic effect of hemangioma treatment against the background of its high severity and an increase in the indicator of apoptosis inhibition of sFas. The influence of the “treatment efficacy” factor leads to a decrease in its cosmetic effect and an increase in the severity of the manifestations of hemangioma against the background of blocking the manifestations of apoptosis. Conclusions. When starting treatment of hemangioma in the early stages, the cosmetic effect increases significantly. A decrease in sFasL in the younger age group may indicate a decrease or absence of apoptosis processes, which is clinically expressed by active proliferation. An increase in sFas in the older age group (over a year old) may indicate a blockage of apoptosis processes and, as a consequence, a slow regression of hemangioma.