What is the diagnosis and treatment for a hemangioma (benign vascular tumor)?

From the Guidelines

Hemangiomas should be treated with oral propranolol as first-line therapy for problematic cases that cause functional impairment, pain, bleeding, or significant cosmetic concerns, with a starting dose of 1-3 mg/kg/day divided into 2-3 doses 1. Hemangiomas are benign vascular tumors that commonly appear in infancy as bright red or bluish marks on the skin. Most hemangiomas require no treatment as they typically go through a growth phase followed by spontaneous regression, with about 90% resolving by age 9. For problematic hemangiomas, treatment options include:

• Oral propranolol as first-line therapy, with a starting dose of 1-3 mg/kg/day divided into 2-3 doses 1
• Topical timolol 0.5% gel (applied twice daily) for superficial lesions
• Corticosteroids for cases unresponsive to beta-blockers
• Laser therapy may be used for residual skin changes after regression Treatment decisions should be individualized based on the hemangioma's location, size, and associated complications. Hemangiomas develop due to abnormal proliferation of endothelial cells and typically follow a predictable course of rapid growth in the first year of life followed by gradual involution over several years. Regular monitoring is essential, especially during the growth phase, to detect any complications requiring intervention. Some key points to consider in the management of hemangiomas include:
• Delaying elective surgical resection until after infancy allows for involution and better outcomes 1
• Medical therapy includes oral propranolol, oral corticosteroids, and intralesional steroid injections 1
• The American Academy of Pediatrics has published a report to provide an update on diagnosing and managing infantile hemangiomas, which includes recommendations for treatment and management 1
• A clinical practice guideline for the management of infantile hemangiomas has been published, which provides guidance on risk stratification and management 1

From the Research

Definition and Treatment of Hemangioma

• Hemangiomas are the most common benign tumors of infancy, often presenting in childhood 2
• Diagnosis is based on clinical history, physical examination, and, when unclear, assisted with ultrasound or MRI 2
• Treatment for symptomatic hemangiomas can be multimodal, including medical treatments such as topical beta blockers, oral propranolol, or steroid injections, as well as surgical resection and laser therapies 2

Comparison of Propranolol and Corticosteroids

• Studies have compared the efficacy of propranolol versus corticosteroids in the treatment of infantile hemangiomas, with propranolol showing a consistent, rapid therapeutic effect compared to prednisolone 3, 4
• A systematic review and meta-analysis found that propranolol had a higher response rate (97%) compared to corticosteroids (69%) after 12 months of follow-up 5
• Propranolol has been shown to have fewer side effects and a different mechanism of action compared to corticosteroids, making it a potentially emerging and effective treatment for infantile hemangiomas 5

Specific Studies on Propranolol

• A study published in the World Journal of Plastic Surgery found that oral propranolol significantly decreased the Hemangioma Activity Score (HAS) compared to oral prednisolone, with good parent satisfaction and minimal adverse effects 3
• A case series published in the International Journal of Pediatric Otorhinolaryngology found that oral propranolol was successfully used to treat airway hemangiomas, resulting in rapid airway stabilization and reducing the need for operative intervention 6
• A randomized controlled study published in the Journal of Pediatric Surgery found that propranolol had a consistent, rapid therapeutic effect compared to prednisolone, with a combination of the two having a comparable but not higher efficacy than propranolol alone 4