Late growth of infantile hemangiomas in children >3 years of age: A retrospective study

Abstract

Background: The proliferative phase of infantile hemangiomas (IHs) is usually complete by 9 months of life. Late growth beyond age 3 years is rarely reported.Objective: To describe the demographic and clinic characteristics of a cohort of patients with late growth of IH, defined as growth in a patient [3 years of age.Methods: A multicenter, retrospective cohort study.Results: In total, 59 patients, 85% of which were female, met the inclusion criteria. The mean first episode of late growth was 4.3 (range 3-8.5) years. Head and neck location (55/59; 93%) and presence of deep hemangioma (52/59; 88%) were common characteristics. Posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities (PHACE) syndrome was noted in 20 of 38 (53%) children with segmental facial IH. Systemic therapy (corticosteroid or b-blocker) was given during infancy in 58 of 59 (98%) and 24 of 59 (41%) received systemic therapy (b-blockers) for late IH growth. Limitations:The retrospective nature and ascertainment by investigator recall are limitations of the study. Conclusion:Late IH growth can occur in children after 3 years of age. Risk factors include head and neck location, segmental morphology, and involvement of deep dermal/subcutaneous tissues.

Childhood Vascular Tumors

“…Most of these lategrowth hemangiomas were classified as deep or mixed type hemangiomas (6). Growth after 36 months of age is rarely reported and more common in segmental hemangiomas of the head and neck and those involving deep and/or subcutaneous structures (7). Involution usually starts around 12-18 months of age, and can last for several years.…”

Unrelenting facial segmental hemangiomas: A case series of late growth and recurrent ulcerations

“…Since the advent of propranolol, a number of reports have documented the incidence and risk factors associated with rebound growth 2,3 . A study of patients with late IH growth found associated factors to be larger IH size, segmental patterning, PHACE syndrome, presence of a deep component, and head and neck location 4 . In that cohort, ulceration was described in a subset of patients at initial presentation, but not as a complication of late or rebound growth.…”

“…The estimated risk of this complication is 25% in patients treated with propranolol 2,3 . IH growth after 3 years of age (late growth) is an uncommonly reported complication 4 . We present a series of three patients with segmental facial IH who experienced late growth and recurrent ulceration of the lower lip, requiring multimodal therapy and unusually prolonged treatment with systemic beta‐blockers.…”

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

“…Multiple lesions are associated with visceral involvement (especially liver and gastro intestinal tract). 3 , 9 , 13 , 14 , 15 Segmental and facial IH show a high risk of unaesthetic sequelae, complications, and recurrence. 9 , 11 , 13 However, there are yet no specific guidelines for the treatment of IH located on this topography, and that have a higher risk of recurrence.…”

“… 3 , 9 , 13 , 14 , 15 Segmental and facial IH show a high risk of unaesthetic sequelae, complications, and recurrence. 9 , 11 , 13 However, there are yet no specific guidelines for the treatment of IH located on this topography, and that have a higher risk of recurrence. It seems obvious to think that for IH at high risk for complications, treatment with propranolol should be prolonged.…”