Growth Characteristics of Infantile Hemangiomas: Implications for Management

Department of Dermatology, University of California, San Francisco, California, USA.
PEDIATRICS (Impact Factor: 5.47). 09/2008; 122(2):360-7. DOI: 10.1542/peds.2007-2767
Source: PubMed


Infantile hemangiomas often are inapparent at birth and have a period of rapid growth during early infancy followed by gradual involution. More precise information on growth could help predict short-term outcomes and make decisions about when referral or intervention, if needed, should be initiated. The objective of this study was to describe growth characteristics of infantile hemangioma and compare growth with infantile hemangioma referral patterns.
A prospective cohort study involving 7 tertiary care pediatric dermatology practices was conducted. Growth data were available for a subset of 526 infantile hemangiomas in 433 patients from a cohort study of 1096 children. Inclusion criteria were age younger than 18 months at time of enrollment and presence of at least 1 infantile hemangioma. Growth stage and rate were compared with clinical characteristics and timing of referrals.
Eighty percent of hemangioma size was reached during the early proliferative stage at a mean age of 3 months. Differences in growth between hemangioma subtypes included that deep hemangiomas tend to grow later and longer than superficial hemangiomas and that segmental hemangiomas tended to exhibit more continued growth after 3 months of age. The mean age of first visit was 5 months. Factors that predicted need for follow-up included ongoing proliferation, larger size, deep component, and segmental and indeterminate morphologic subtypes.
Most infantile hemangioma growth occurs before 5 months, yet 5 months was also the mean age at first visit to a specialist. Recognition of growth characteristics and factors that predict the need for follow-up could help aid in clinical decision-making. The first few weeks to months of life are a critical time in hemangioma growth. Infants with hemangiomas need close observation during this period, and those who need specialty care should be referred and seen as early as possible within this critical growth period.

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    • "Infantile haemangiomas (IHs) are the most common vascular tumours of infancy.[1] IHs grow rapidly during the first 6-12 months of life (the proliferative phase), enters the second stage of growth proportionate with that of child and then enters a phase of slow regression (involuting phase) lasting 1-7 years.[2] In certain anatomic areas IHs may cause disfigurement or threaten vital functions (such as visual oral or airway function) or may become complicated with painful ulceration and bleeding. "
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    ABSTRACT: Infantile haemangiomas are the most common tumor of infancy. We report the use of propranolol for treatment of problematic and complicated haemangiomas. Propranolol was given to 52 children with mean age of 18.2 months at onset of treatment. After clinical and electrocardiographic evaluations, propranolol was administered with a starting dose of 2 mg/kg per day, given in 3 divided doses. Monthly follow up was done, response to oral propranolol therapy and any complications of therapy were recorded. Response to propranolol was classified as Complete Response, Excellent Response, Partial Response and Non Responder. Total 49 patients showed significant improvement after propranolol therapy out of which 4 patients were complete responder, 30 patients (56.7%) were excellent responders; 15 patients (28.8%) were partial responders. 3 patients (5.7%) had growth of haemangiomas despite propranolol therapy and were classified as non-responder. Side effect like hypotension, rashes, gastroesophageal reflux was reported by 3 patients. In our study mean duration of treatment was 6.5 months. At the end of treatment propranolol was stopped by with gradual tapering of dose over a period of 2 weeks. Propranolol administered orally at 2 mg/kg per day has rapid effective therapeutic effect in treatment of ulcerated haemangiomas and it appears to be a valuable and effective treatment option for infantile haemangiomas beyond the proliferative phase, and esthetically disfiguring haemangiomas.
    Journal of Cutaneous and Aesthetic Surgery 03/2014; 7(1):37-41. DOI:10.4103/0974-2077.129975
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    • "The standard treatment options for IH include corticosteroids or surgical excision, and the options in life- or sight-threatening cases include treatment with vincristine, interferon or cyclophosphamide. Unfortunately, none of these therapeutic modalities are ideal due to restrictions or potential serious side effects [4-7]. β-blockers have recently been introduced as a safe and effective treatment for IH [8-11]. "
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    ABSTRACT: Infantile hemangioma (IH), which is the most common tumor in infants, is a benign vascular neoplasm resulting from the abnormal proliferation of endothelial cells and pericytes. For nearly a century, researchers have noted that IH exhibits diverse and often dramatic clinical behaviors. On the one hand, most lesions pose no threat or potential for complication and resolve spontaneously without concern in most children with IH. On the other hand, approximately 10% of IHs are destructive, disfiguring and even vision- or life-threatening. Recent studies have provided some insight into the pathogenesis of these vascular tumors, leading to a better understanding of the biological features of IH and, in particular, indicating that during hemangioma neovascularization, two main pathogenic mechanisms prevail, angiogenesis and vasculogenesis. Both mechanisms have been linked to alterations in several important cellular signaling pathways. These pathways are of interest from a therapeutic perspective because targeting them may help to reverse, delay or prevent hemangioma neovascularization. In this review, we explore some of the major pathways implicated in IH, including the VEGF/VEGFR, Notch, beta-adrenergic, Tie2/angiopoietins, PI3K/AKT/mTOR, HIF-alpha-mediated and PDGF/PDGF-R-beta pathways. We focus on the role of these pathways in the pathogenesis of IH, how they are altered and the consequences of these abnormalities. In addition, we review the latest preclinical and clinical data on the rationally designed targeted agents that are now being directed against some of these pathways.
    Journal of Hematology & Oncology 01/2014; 7(1):13. DOI:10.1186/1756-8722-7-13 · 4.81 Impact Factor
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    • "The capillary type, also known as the strawberry he‐ mangioma is composed of small thin-walled vessels of capillary size that are lined by a sin‐ gle layer of flattened or plump endothelial cells and surrounded by a discontinuous layer of pericytes and reticular fibers [9] [10] (Figures 1and 2). It was first described in the literature in 1973 by Sznajder et al.[11], under the term "Hemorrhagic hemangioma" [10]. "
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