Infantile hemangiomas: How common are they? A systematic review of the medical literature
ABSTRACT No published prospective studies have been published for several decades examining the incidence of hemangiomas. Older studies were performed before the delineation of "hemangiomas" from other vascular birthmarks was well-established. The objective of our study is to critically re-examine the literature reporting the incidence of infantile hemangiomas to determine if the true incidence is actually known. We performed both an electronic database search and hand search of the medical literature on the natural history of hemangiomas in full-term newborns and infants. A total of seven articles were found comprising two study populations: newborns <2 weeks of age and infants over the age of 2 weeks. All studies included samples sizes >500 patients including both hospital-based and primary care settings. Study designs ranged from retrospective chart reviews to cross-sectional cohort studies. Descriptive nomenclature was not uniform between studies, and all had methodologic limitations including problems of definition and study design. Studies estimating the true incidence of infantile hemangiomas are all many decades old and have significant methodologic issues limiting their ability to determine hemangioma incidence. Future studies in primary care settings using the currently accepted classification schema of vascular birthmarks may more accurately define the incidence and potential impact of this common vascular tumor of infancy.
[Show abstract] [Hide abstract]
ABSTRACT: To provide a guideline for Chinese clinicians regarding oral propranolol treatment on infantile hemangioma (IH). A survey for management of propranolol therapy (clinical consultation, dosage initiation, dosage changing, monitoring of complications and effectiveness evaluation) was performed and was delivered to the Division of Vascular Anomalies (DVA), Chinese Stomatological Association (CSA), and to the Division of Hemangioma and Vascular Malformations (DHVM), Chinese Society of Plastic and Reconstructive Surgery. Data from 31 hospitals were collected and analyzed. In all hospitals, IH patients were treated with oral propranolol as a routine. Twenty-two (71%) of the 31 hospitals treated patients with IH as part of a multidisciplinary strategy. Cardiology consultation was routinely sought in 21 (95%) of these 22 hospitals before initiation of propranolol therapy. Sixteen hospitals (52%) recommend an initial propranolol dose of 1 to 1.5 mg/kg/day, in most cases 1.0 mg/kg/day. The dosage frequency of once a day was recommended in 18 (58%) of the surveyed hospitals. The maximum dose of 1.5 mg/kg/day or 2.0 mg/kg/day was suggested in 10 (32%) and 13 (42%) hospitals, respectively. Similarly, the optimal dose of 1.5 mg/kg/day or 2.0 mg/kg/day was recommended in 11 (37%) and 9 (30%) hospitals, respectively. The duration of therapy varied from 1 to 24 months. Tapering was advised by 10 (40%) hospitals and immediate discontinuation was applied in 13 (52%) hospitals. Complications were emphasized by all hospitals. The most common complications were gastrointestinal symptoms (17 of 31 hospitals), whereas the complication most commonly monitored for was changes in heart rate. No rebound effects were reported. Propranolol has become the first-line agent for IH in mainland China. This is a practical survey which is helpful to standardize and develop a guideline for propranolol therapy.International Journal of Clinical and Experimental Medicine 01/2015; 8(2):2138-46. · 1.42 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Oral propranolol has been used to treat complicated infantile hemangiomas, although data from randomized, controlled trials to inform its use are limited. We performed a multicenter, randomized, double-blind, adaptive, phase 2-3 trial assessing the efficacy and safety of a pediatric-specific oral propranolol solution in infants 1 to 5 months of age with proliferating infantile hemangioma requiring systemic therapy. Infants were randomly assigned to receive placebo or one of four propranolol regimens (1 or 3 mg of propranolol base per kilogram of body weight per day for 3 or 6 months). A preplanned interim analysis was conducted to identify the regimen to study for the final efficacy analysis. The primary end point was success (complete or nearly complete resolution of the target hemangioma) or failure of trial treatment at week 24, as assessed by independent, centralized, blinded evaluations of standardized photographs. Of 460 infants who underwent randomization, 456 received treatment. On the basis of an interim analysis of the first 188 patients who completed 24 weeks of trial treatment, the regimen of 3 mg of propranolol per kilogram per day for 6 months was selected for the final efficacy analysis. The frequency of successful treatment was higher with this regimen than with placebo (60% vs. 4%, P<0.001). A total of 88% of patients who received the selected propranolol regimen showed improvement by week 5, versus 5% of patients who received placebo. A total of 10% of patients in whom treatment with propranolol was successful required systemic retreatment during follow-up. Known adverse events associated with propranolol (hypoglycemia, hypotension, bradycardia, and bronchospasm) occurred infrequently, with no significant difference in frequency between the placebo group and the groups receiving propranolol. This trial showed that propranolol was effective at a dose of 3 mg per kilogram per day for 6 months in the treatment of infantile hemangioma. (Funded by Pierre Fabre Dermatologie; ClinicalTrials.gov number, NCT01056341.).New England Journal of Medicine 02/2015; 372(8):735-46. DOI:10.1056/NEJMoa1404710 · 54.42 Impact Factor
Article: Hemangiomas and the eye[Show abstract] [Hide abstract]
ABSTRACT: Infantile hemangiomas are a common vascular birthmark with heterogeneous presentations and unique growth characteristics with early rapid growth and eventual self-involution. Hemangiomas that develop around the eye have the potential for inducing amblyopia by several mechanisms and may eventually result in permanent visual impairment in otherwise healthy infants. Segmental periocular hemangiomas carry the additional risk of associated structural anomalies and PHACE syndrome. In recent years, the treatment of periocular hemangiomas has been revolutionized by the serendipitous discovery of the effectiveness of beta-blockers (systemic and topical), with most experts viewing these as first-line therapies. The management of periocular hemangiomas should involve a close partnership between an ophthalmologist and dermatologist or other relevant specialists familiar with the unique clinical features, differential diagnosis, treatment approaches, and potential complications. Copyright © 2015 Elsevier Inc. All rights reserved.Clinics in Dermatology 04/2015; 33(2). DOI:10.1016/j.clindermatol.2014.10.009 · 1.93 Impact Factor