From the Guidelines
Hemangiomas that are potentially problematic due to their size or location should be treated with oral propranolol at a dose of 2 to 3 mg/kg per day, as it is the drug of choice for systemic treatment, as recommended by the American Academy of Pediatrics 1. When considering treatment for hemangiomas, it is essential to prioritize those that may cause permanent scarring and disfigurement, such as facial hemangiomas, or those that may lead to functional impairment, like periorbital hemangiomas. Key points to consider when treating hemangiomas include:
- Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic hemangiomas 1.
- Propranolol is the first-line treatment for systemic therapy, with a recommended dose of 2 to 3 mg/kg per day, continued for at least 6 months and often maintained until 12 months of age 1.
- Topical timolol may be used to treat select small, thin, superficial hemangiomas, while surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution 1.
- Parents should be counseled about the natural history of hemangiomas and potential side effects of treatment, including sleep disturbances, bronchospasm, and hypoglycemia with propranolol 1. The most recent and highest quality study, published in 2019, provides a comprehensive clinical practice guideline for the management of infantile hemangiomas, emphasizing the importance of early intervention and propranolol as the drug of choice for systemic treatment 1.
From the Research
Definition and Prevalence of Hemangiomata
- Hemangiomata, also known as infantile hemangiomas, are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life 2.
- They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches, and then grow rapidly in the first 3 to 6 months of life 2.
Treatment Options for Hemangiomata
- The majority of infantile hemangiomas require no treatment, but treatment options include oral propranolol, topical timolol, and oral corticosteroids 2.
- Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration, interference with vital structures, life- or function-threatening complications, and significant disfigurement 2.
- Propranolol is currently the treatment of choice for high-risk and complicated infantile hemangiomas, with a high success rate and minimal adverse effects 3, 4.
Comparison of Propranolol and Corticosteroids
- Propranolol therapy has been shown to be more clinically effective and cost-effective than oral corticosteroids in treating infantile hemangiomas, with fewer surgical interventions and minimal adverse effects 4, 5.
- Patients treated with propranolol had a lower odds of requiring surgical intervention compared to those treated with corticosteroids 5.
Complications and Special Considerations
- Hemangiomatosis, or multiple hemangiomas, can be associated with visceral involvement and high-output cardiac failure, requiring a comprehensive therapeutic approach 6.
- Prematurity has been associated with an increased need for surgical intervention, regardless of the modality of medical treatment 5.