What is a capillary hemangioma?

From the Guidelines

Capillary hemangiomas should be treated with oral propranolol as first-line therapy for problematic cases, with a dose of 2 to 3 mg/kg per day, as recommended by the most recent clinical practice guideline for the management of infantile hemangiomas 1.

Key Considerations

• Most capillary hemangiomas require no treatment as they typically undergo spontaneous regression, with 50% resolving by age 5 and 90% by age 9.
• For problematic hemangiomas causing functional impairment, pain, bleeding, or significant cosmetic concerns, treatment options include oral propranolol as first-line therapy, with treatment typically continuing for 6-12 months.
• Topical timolol 0.5% gel may be used for smaller, superficial lesions.
• Alternative treatments include systemic or intralesional corticosteroids, laser therapy, or surgical excision for select cases.
• Patients should be monitored for potential side effects of propranolol including hypoglycemia, bradycardia, hypotension, and sleep disturbances.

Management Approach

• Early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs 1.
• Imaging is not usually necessary, but ultrasonography is the preferred initial modality if indicated 1.
• Interventions are needed if the patient has a life-threatening condition, an existing or imminent functional impairment, pain, or bleeding.
• The management of ulcerative infantile hemangiomas focuses on wound care, controlling pain, controlling growth, and preventing and treating secondary infections 1.

Treatment Options

• Oral propranolol is the drug of choice at a dose of 2 to 3 mg/kg per day, with treatment typically continuing for at least 6 months and often maintained until 12 months of age (occasionally longer) 1.
• Topical timolol may be used to treat select small, thin, superficial IHs.
• Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some IHs 1.

From the Research

Definition and Characteristics of Capillary Hemangioma

• Capillary hemangioma, also known as infantile hemangioma, is a nonmalignant vascular tumor that commonly affects children 2.
• It is the most common congenital vascular tumor in the periocular region 3.
• 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 2.

Treatment Options for Capillary Hemangioma

• β-blockers, such as propranolol, have become a mainstay of therapy given their relatively low-risk profile and efficacy 2, 3.
• Other treatment modalities include corticosteroids, imiquimod, vincristine, bleomycin A5, and interferon α 2.
• Laser therapy and surgical excision are also available treatment options 2.
• Cryosurgery has been shown to be effective in treating capillary hemangiomas, particularly in young children 4.
• 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 5.

Effectiveness of Propranolol in Treating Capillary Hemangioma

• Propranolol has been shown to be an effective and safe treatment for periocular capillary hemangioma, with a rapid therapeutic effect and significant reduction in astigmatic error 6, 3.
• Improvement or complete resolution of the lesions occurred in 96% of cases treated with propranolol, with recurrence noted in one-fifth of cases 3.
• Propranolol is currently the treatment of choice for high-risk and complicated infantile hemangiomas 5.