Growth Characteristics of Infantile Hemangiomas: Implications for Management

OBJECTIVES. 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. METHODS. 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. RESULTS. 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. CONCLUSIONS. 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.

[1]  Thomas J Gampper,et al.  Vascular anomalies: hemangiomas. , 2002, Plastic and reconstructive surgery.

[2]  M. Colombo,et al.  Ulcerated hemangiomas: clinical characteristics and response to therapy. , 2001, Journal of the American Academy of Dermatology.

[3]  A. Margileth,et al.  Current concepts in diagnosis and management of congenital cutaneous hemangiomas. , 1965, Pediatrics.

[4]  M. Garzón,et al.  How to Measure a Growing Hemangioma and Assess Response to Therapy , 2006, Pediatric dermatology.

[5]  Gordon Hiroshi Sasaki Symposium on Vascular Malformations and Melanotic Lesions , 1984 .

[6]  R. Marcucio,et al.  Patterns of Infantile Hemangiomas: New Clues to Hemangioma Pathogenesis and Embryonic Facial Development , 2006, Pediatrics.

[7]  Michael I Dorrell,et al.  Identifying potential regulators of infantile hemangioma progression through large-scale expression analysis: a possible role for the immune system and indoleamine 2,3 dioxygenase (IDO) during involution. , 2003, Lymphatic research and biology.

[8]  W. Lister THE NATURAL HISTORY OF STRAWBERRY NÆVI , 1938 .

[9]  J. Mulliken,et al.  The Current Management of Vascular Birthmarks , 1993, Pediatric dermatology.

[10]  J. Mulliken,et al.  Vascular Birthmarks: Hemangiomas and Malformations , 1988 .

[11]  A. Fleischer,et al.  Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation. , 2001, Archives of dermatology.

[12]  J. Resneck,et al.  Challenges facing academic dermatology: survey data on the faculty workforce. , 2006, Journal of the American Academy of Dermatology.

[13]  D. Passaro,et al.  Hemangiomas of infancy: clinical characteristics, morphologic subtypes, and their relationship to race, ethnicity, and sex. , 2002, Archives of dermatology.

[14]  E. Pope,et al.  Topical imiquimod in the treatment of infantile hemangiomas: a retrospective study. , 2007, Journal of the American Academy of Dermatology.

[15]  L. J. Hoeve,et al.  Subglottic hemangiomas in infants: treatment with intralesional corticosteroid injection and intubation. , 1990, International journal of pediatric otorhinolaryngology.

[16]  I. Frieden,et al.  Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. , 2007, The Journal of pediatrics.

[17]  L. Bivings Spontaneous regression of angiomas in children; twenty-two years' observation covering 236 cases. , 1954, The Journal of pediatrics.

[18]  D. Siegel,et al.  Infantile Hemangiomas: Current Knowledge, Future Directions. Proceedings of a Research Workshop on Infantile Hemangiomas , 2005, Pediatric dermatology.

[19]  E. E. Covington Management of hemangiomas. , 1961, Pediatric dermatology.

[20]  M. Mihm,et al.  The nonrandom distribution of facial hemangiomas. , 2003, Archives of dermatology.

[21]  I. Frieden,et al.  Prospective Study of Infantile Hemangiomas: Clinical Characteristics Predicting Complications and Treatment , 2006, Pediatrics.

[22]  A. H. Jacobs Strawberry hemangiomas; the natural history of the untreated lesion. , 1957, California medicine.

[23]  I. Frieden,et al.  Hemangiomas in children. , 1999, The New England journal of medicine.

[24]  N. Esterly Cutaneous hemangiomas, vascular stains and malformations, and associated syndromes. , 1996, Current problems in pediatrics.

[25]  R. Geronemus,et al.  Failure of the Flashlamp‐Pumped Pulsed Dye Laser to Prevent Progression to Deep Hemangioma , 1993, Pediatric dermatology.