From the Guidelines
Hemangiomas of the hand should be treated with oral propranolol as the first-line agent, with a dose of 2-3 mg/kg per day, unless there are contraindications or an inadequate response, in which case oral prednisolone or prednisone may be prescribed 1. When managing hemangiomas of the hand, it is essential to consider the potential for functional impairment, pain, or bleeding, and to treat accordingly. The American Academy of Pediatrics recommends that hemangiomas be treated in the setting of a life-threatening condition, functional impairment, pain, or bleeding 1.
Key Considerations
- Hemangiomas are benign vascular tumors that typically appear as red or purplish growths on the skin, and most do not require treatment as they often spontaneously regress, particularly in children 1.
- For symptomatic or problematic hemangiomas, treatment options include observation, compression therapy, oral propranolol, topical timolol 0.5% gel, corticosteroids, laser therapy, sclerotherapy, or surgical excision for persistent cases.
- Treatment choice depends on the hemangioma's size, location, symptoms, and patient age, and regular monitoring is essential, especially for deep hemangiomas that might not be fully visible on the surface 1.
Management
- Oral propranolol is the first-line agent for hemangiomas requiring systemic treatment, with a dose of 2-3 mg/kg per day, unless there are comorbidities or adverse effects that necessitate a lower dose 1.
- Intralesional injection of triamcinolone and/or betamethasone may be recommended to treat focal, bulky hemangiomas during proliferation or in certain critical anatomic locations 1.
- Topical timolol maleate may be prescribed as a therapy for thin and/or superficial hemangiomas 1.
- Surgical management, including surgery and laser therapy, may be recommended as treatment options in managing selected hemangiomas 1.
From the Research
Characteristics of Hemangioma
- Hemangioma is the most common benign tumor in infancy, with over 90% requiring no treatment 2
- Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life 3
- Hemangiomas often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches, and grow rapidly in the first 3 to 6 months of life 3
Treatment Options
- Propranolol has established itself as the first-line treatment for hemangiomas 2
- Pulsed dye laser has proven effective in the treatment of ulcerated hemangiomas 2
- Corticosteroid therapy is applied only rarely, but surgical treatment or angiography and embolization therapy associated with it may sometimes be indicated 2
- Oral propranolol is the treatment of choice for high-risk and complicated infantile hemangiomas 3
- Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol 3
Hemangioma of the Hand
- The authors describe the anatomopathological and clinical findings of 24 cases of benign hemangioma of the hand, with MRI imaging given particular importance in the preoperative evaluation 4
- Wide resection of the tumor is the only means of avoiding recurrence, with an average follow-up of 33 months showing recurrence in 7% of the cases treated 4
Comparative Studies
- A retrospective comparative study compared the clinical effectiveness of oral propranolol with that of oral prednisone in the treatment of infantile hemangiomas, showing propranolol to be superior in inducing more-rapid and greater clinical improvement 5
- Surgical excision is the preferred treatment for symptomatic deep subdermal or intramuscular hemangioma, with intralesional or marginal excision yielding satisfactory results for pain relief, functional recovery, and avoidance of recurrence 6