From the Guidelines
Congenital hemangiomas and infantile hemangiomas are distinct vascular tumors that differ primarily in their timing of appearance and growth patterns, with congenital hemangiomas being fully formed at birth and infantile hemangiomas undergoing rapid proliferation during the first few months of life. The key differences between these two types of hemangiomas are their clinical presentation, growth patterns, and management approaches. Congenital hemangiomas are fully grown at birth and can be classified into three subtypes: rapidly involuting (RICH), non-involuting (NICH), and partially involuting (PICH) 1. In contrast, infantile hemangiomas are either absent or minimally present at birth and undergo a predictable lifecycle with a proliferation phase, plateau phase, and involution phase 1.
Clinical Presentation and Growth Patterns
Infantile hemangiomas usually appear by four weeks of age and stop enlarging by five months of age, with up to 70% leading to residual skin changes, including telangiectasia, fibrofatty tissue, redundant skin, atrophy, dyspigmentation, and scarring 1. Congenital hemangiomas, on the other hand, are present at birth and can be rapidly involuting or noninvoluting. The distinction between these two types of hemangiomas is crucial for management, as infantile hemangiomas often require more active monitoring during their proliferative phase, while the management of congenital hemangiomas depends on their subtype and whether they are causing functional impairment.
Histological Differences
Histologically, infantile hemangiomas stain positive for GLUT-1, a reliable marker absent in congenital hemangiomas 1. This distinction is important for diagnosis and management, as it can help guide treatment approaches.
Treatment Approaches
Treatment approaches for congenital and infantile hemangiomas vary based on type, location, and complications. Options include observation, beta-blockers like propranolol (2-3 mg/kg/day divided into two doses for 6-12 months for infantile hemangiomas), laser therapy, or surgical excision 1. The choice of treatment depends on the specific characteristics of the hemangioma and the presence of any complications or functional impairment.
Management Guidelines
The American Academy of Pediatrics has published guidelines for the management of infantile hemangiomas, emphasizing the importance of early intervention and referral for potentially problematic hemangiomas 1. The British Society for Paediatric Dermatology has also published guidelines for the use of propranolol in the treatment of infantile hemangiomas, providing evidence-based guidance on the use of this medication in clinical practice 1.
In summary, the distinction between congenital and infantile hemangiomas is crucial for management, and treatment approaches should be guided by the specific characteristics of the hemangioma and the presence of any complications or functional impairment. The management of congenital and infantile hemangiomas should prioritize minimizing morbidity, mortality, and optimizing quality of life, with treatment approaches tailored to the individual patient's needs.
From the Research
Difference between Congenital Hemangioma and Infantile Hemangioma
The key differences between congenital hemangioma and infantile hemangioma are:
- Time of Formation: Congenital hemangiomas are fully formed at birth 2, whereas infantile hemangiomas typically appear after birth and proliferate rapidly during the early infantile period 3.
- Histological and Immunohistochemical Findings: Congenital hemangiomas differ from infantile hemangiomas in their histological and immunohistochemical findings, representing a distinct clinical entity 2.
- Clinical Characteristics: Congenital hemangiomas can be divided into two subtypes: rapidly involuting congenital hemangioma (RICH) and non-involuting congenital hemangioma (NICH) 4. Infantile hemangiomas, on the other hand, have a characteristic natural course of proliferation followed by gradual regression 3.
- Imaging Characteristics: Congenital hemangiomas have distinctive imaging features, such as visible vessels and calcifications on ultrasound, and well-defined limits and fat stranding on CT and/or MRI 4. Infantile hemangiomas have different imaging characteristics, with common features including a well-defined margin and no visible vessels or calcifications 4.
- Management: The management of congenital hemangiomas and infantile hemangiomas differs. While some infantile hemangiomas may require treatment with systemic corticosteroids, beta-blockers, or other therapies 3, congenital hemangiomas may require endovascular embolization and/or direct percutaneous sclerotherapy 5.
Subtypes of Congenital Hemangioma
There are two subtypes of congenital hemangioma:
- Rapidly Involuting Congenital Hemangioma (RICH): This subtype is characterized by rapid involution after birth 4.
- Non-Involuting Congenital Hemangioma (NICH): This subtype does not involute and may require treatment to prevent morbidity 5.
Clinical Implications
Understanding the differences between congenital hemangioma and infantile hemangioma is crucial for proper diagnosis and management. A multidisciplinary approach, including a "Vascular Anomalies Team," is recommended for the treatment of these conditions 6.