Access Dermatology

Summary

Life-threatening hemangiomas affect a minority of the infants due to the growth of one or several infantile hemangiomas, the most common benign vascular tumor of infancy and childhood. The prognosis may be alarming because of visceral locations. In these settings, airway locations are sometimes extremely difficult to control and they may affect the prognosis. Liver hemangiomas, when diffuse, are at risk of high-output cardiac failure, liver failure, and death in the neonatal period. Broadly expanding superficial hemangiomas that are ulcerated, infected, and creating cardiac vascular overload are sometimes life-threatening conditions. In rare cases, intracranial arterial malformations, as part of the PHACES syndrome, are present; they can induce stroke, even in neonates. It must be emphasized that Kasabach-Merritt syndrome, its profound thrombocytopenia and coagulopathy, can induce lethal visceral hemorrhages in the neonatal period, but it is not a complication of infantile hemangioma; it engrafts on different vascular tumors (kaposiform hemangioendothelioma and tufted angioma). Management of life-threatening infantile hemangiomas is often a daunting problem. Medical treatments include systemic corticosteroids, interferon-alpha-2a and alpha-2b, vincristine, cyclophosphamide. Multimodal chemotherapy is considered for the most serious cases, sometimes in combination with arterial embolization. Treatments may fail. Their various adverse effects are inevitable, and they can also be life-threatening.