From the Guidelines
Infantile hemangiomas (strawberry hemangiomas) that are potentially problematic due to their size, location, or associated complications should be treated with oral propranolol as the first-line therapy, at a dose of 2 to 3 mg/kg per day, as recommended by the most recent and highest quality study 1. The diagnosis of infantile hemangioma is typically made based on clinical presentation, with most hemangiomas appearing as bright red, raised lesions in the first few weeks of life. Key considerations in the diagnosis and treatment of infantile hemangiomas include:
- Monitoring for complications such as ulceration, bleeding, vision obstruction, or airway compromise
- Assessing the risk of disfigurement or functional impairment
- Considering early intervention, ideally by 1 month of age, for potentially problematic hemangiomas
- Using oral propranolol as the first-line treatment, with topical timolol, laser therapy, or surgical excision as alternative or adjunctive options The most recent and highest quality study 1 provides guidance on the management of infantile hemangiomas, emphasizing the importance of early intervention and the use of propranolol as the first-line treatment. Other studies, such as 1 and 1, also support the use of propranolol in the treatment of infantile hemangiomas, but are less recent and of slightly lower quality. In terms of specific treatment options, the study by 1 recommends:
- Oral propranolol at a dose of 2 to 3 mg/kg per day for systemic treatment
- Topical timolol for select small, thin, superficial hemangiomas
- Surgery and/or laser treatment for residual skin changes after involution, or in select cases where earlier treatment is necessary. Overall, the diagnosis and treatment of infantile hemangiomas require careful consideration of the individual patient's needs and the potential risks and benefits of different treatment options, with a focus on minimizing morbidity, mortality, and impact on quality of life.
From the Research
Diagnosis of Infantile Hemangioma
- Infantile hemangiomas are nonmalignant vascular tumors that commonly affect children, typically appearing in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches 2.
- They often grow rapidly in the first 3 to 6 months of life, with superficial lesions being bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated, while deep lesions are bluish and dome-shaped 2.
- The natural disease course typically involves growth for up to a year, followed by regression without treatment over a period of years with no cosmetic or functional sequelae 3.
Treatment of Infantile Hemangioma
- 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 in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement 2.
- β-blockers, such as propranolol, have become a mainstay of therapy given their relatively low-risk profile and efficacy 3.
- Other treatment modalities include corticosteroids, imiquimod, vincristine, bleomycin A5, and interferon α, as well as laser therapy and surgical excision 3, 4.
- Propranolol is considered the first-line treatment for infantile hemangiomas, with high success rates reported in both cutaneous and complicated forms 5.
- However, failure of propranolol treatment has been reported, and more attention should be given to the cases that poorly or negatively respond to treatment 5.
Treatment Outcomes
- Studies have shown that pulsed dye laser therapy can result in complete clearance of infantile hemangiomas, with significant reductions in redness and size 4.
- Oral prednisolone has been shown to reduce the size of infantile hemangiomas compared to intravenous methylprednisolone 4.
- Bleomycin has also been shown to reduce the surface area of infantile hemangiomas 4.
- Early treatment with argon laser has been reported to be successful in aborting the life cycle of infantile hemangiomas 6.