Access Dermatology

Introduction

Infantile hemangiomas (IH) are common, benign, vascular tumors of infancy which have a characteristic clinical appearance and predictable natural history. Classically, IH are not present at birth, but are noted shortly thereafter. They proliferate for the first several months of life, often rapidly, and then enter a stage of gradual involution. For the vast majority of IH, no treatment is ever necessary, as generally most involute completely over years without significant scarring. However, for a minority of patients, hemangiomas can be life- or function-threatening, or risk causing permanent disfigurement, and these are the patients for whom treatment is needed.

Which specific treatment and why depends on the age of the patient, location, size, and anticipated complications. Due to the heterogeneity of infantile hemangiomas, the decision about when and how to intervene with treatment(s) are made on an individual basis (1). Even in cases where high-risk or concerning features are absent, but the rationale for treatment is uncertain, active non-intervention is necessary (see below) (2). The rationales for treatment are very diverse but can be separated into three distinct categories, as listed below with specific clinical scenarios for each of these areas:

1) To prevent potentially life-threatening complications

a. Airway hemangioma
b. Hepatic hemangioma
c. Giant hemangioma with or without internal involvement

2) To minimize or prevent functional impairment or pain

a. Ulcerated hemangioma
b. Periorificial hemangioma (periorbital, lip, anogenital)
c. Lumbosacral hemangioma
d. Segmental extremity hemangioma

3) To minimize or prevent scarring and disfigurement

a. Large/segmental facial hemangioma
b. Periocular/periauricular hemangioma
c. Central facial hemangioma developing prominent dermal component
d. Nasal tip hemangioma
e. Pedunculated hemangioma

Discussion of potential treatments for infantile hemangiomas requires in-depth knowledge of their natural history and early recognition of possible associations and complications.