Persistent dysesthesias in involuted infantile hemangiomas: An uncommon complication in a common condition

Abstract

Background/Objectives Infantile hemangiomas (IHs) are common benign vascular tumors of infancy. IHs tend to grow in the first few months of life and then gradually involute over years, often leaving fibrofatty residua or textural changes in their place. Classically, these lesions are painless throughout their entire natural history; however, we now report on seven patients with involuted IH with intermittent but persistent sensory symptoms. Methods This is a multicenter case series in which members of the Birthmarks Focused Study Group of the Pediatric Dermatology Research Alliance (PeDRA) and the Hemangioma Investigator Group contributed patients with IH and dysesthesias from their clinical practices. Charts were then reviewed to document clinical details. Results Seven patients were included, presenting at an average age of 14.6 years (range 3‐48 years) for complaints related to discomfort in the region of involuted IH. The majority (6/7) reported pain or tenderness to the area. One patient reported pruritus. All patients reported intermittent symptoms. The length of symptoms ranged between 4 months and 5 years. Treatment was attempted in 5/7 patients. Ice, oral propranolol, topical capsaicin, and intralesional triamcinolone partially improved symptoms. Conclusions Persistent cutaneous dysesthesias were present in seven patients, in most cases many years after completion of involution. Further research is needed to fully elucidate the pathophysiology and optimal treatments for this IH complication.

Immediate possible adverse event rates in infants treated with oral propranolol for infantile haemangiomas at an Australian urban tertiary hospital between 2016 and 2019

“…They are generally not present or minimal at birth and exhibit a characteristic life cycle with two evolutionary phases, proliferation and involution 1,2 . Proliferation occurs typically in early infancy, and gradual spontaneous involution begins at 1 year of age, with results ranging from complete resolution to residual skin change 3,4 . Untreated 50–70% of IHs resolve, leaving residual skin changes, including scar, dyspigmentation, fibrofatty tissue or redundant skin 5 .…”

“…1,2 Proliferation occurs typically in early infancy, and gradual spontaneous involution begins at 1 year of age, with results ranging from complete resolution to residual skin change. 3,4 Untreated 50-70% of IHs resolve, leaving residual skin changes, including scar, dyspigmentation, fibrofatty tissue or redundant skin. 5 A small number can interfere with airway or visual functioning, 6 ulcerate and cause bleeding.…”