Background:
Infantile hemangiomas are the most common vascular tumors of infancy affecting up to 12% of
infants by the first year of life.
Objective:
To familiarize physicians with the natural history, clinical manifestations, diagnosis, and management of infantile
hemangiomas.
Methods:
A Pubmed search was conducted in November 2019 in Clinical Queries using the key term "infantile hemangioma".
The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews
published within the past 20 years. Only papers published in the English literature were included in this review. The information
retrieved from the above search was used in the compilation of the present article.
Results:
The majority of infantile hemangiomas are not present at birth. They often appear in the first few weeks of life as areas
of pallor, followed by telangiectatic telangiectatic or faint red patches. They then grow rapidly in the first 3 to 6 months of life.
Superficial lesions are bright red, protuberant, bosselated or with a smooth surface, and sharply demarcated. Deep lesions are
bluish and dome-shaped. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate
slows down to parallel the growth of the child. Involution typically begins by the time the child is a year old. Approximately 50%
of infantile hemangiomas will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7;
and 95% will have regressed by 10 to 12 years of age. The majority of infantile hemangiomas require no treatment. Treatment
options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage
unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital
structures, life- or function-threatening complications, and significant disfigurement.
Conclusion:
Treatment should be individualized, depending upon the size, rate of growth, morphology, number and location of
the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient,
level of parental concern, and the physician's comfort level with the various treatment options. Currently, oral propranolol is the
treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be considered for superficial
infantile hemangiomas which need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse
events from oral administration of propranolol.
