From the Guidelines
No, the scalp is not considered part of the face when calculating the Infantile Hemangioma Severity (IHS) scoring system. The IHS scoring system specifically divides the body into anatomic regions, with the face being considered separate from the scalp. When assessing hemangiomas using this system, facial involvement is scored separately and often weighted more heavily due to the potential for functional and cosmetic concerns. The scalp is categorized as its own distinct region. This distinction is important because facial hemangiomas may have different implications for treatment decisions and risk assessment compared to scalp hemangiomas. Facial hemangiomas can potentially affect vital structures like eyes, nose, or mouth, while scalp hemangiomas are generally less likely to cause functional impairment.
Key Points to Consider
- Facial IHs are complicated more frequently than nonfacial IHs, as noted in 1
- Segmental IHs of the face have been observed to conform to unique developmental units, which have been mapped into 4 distinct patterns: frontotemporal, maxillary, mandibular, and frontonasal, as described in 1
- The presence of more than 5 focal IHs suggests a higher risk of hepatic involvement, according to 1 When documenting hemangioma location for IHS scoring, practitioners should clearly differentiate between facial and scalp involvement to ensure accurate assessment and appropriate management planning.
From the Research
Definition of Face in IHS Scoring
- The provided studies do not explicitly define whether the scalp is considered part of the face when calculating IHS scoring for hemangioma 2, 3, 4, 5, 6.
IHS Scoring Systems
- There are various scoring systems for infantile hemangiomas, such as the Hemangioma Activity and Severity Index (HASI) 3 and the Infantile Hemangioma Referral Score (IHReS) 6.
- These scoring systems evaluate the severity and activity of infantile hemangiomas, but do not provide a clear definition of the face in relation to IHS scoring.
Location of Hemangiomas
- Infantile hemangiomas can occur anywhere on the body, including the face and scalp 4, 5.
- The location of the hemangioma is an important factor in determining the need for treatment and the potential risks associated with the condition.
Treatment and Referral
- The decision to refer a patient with an infantile hemangioma to an expert center depends on various factors, including the size, location, and severity of the hemangioma 6.
- The IHReS tool is a validated instrument for primary physicians to determine the need for referral, but it does not provide a clear definition of the face in relation to IHS scoring 6.