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Infantile hemangiomas are the most common type of vascular anomaly, occurring in 4 to 10 percent of infants and more frequently in premature babies. The growths are typically noticed within the first two weeks of birth and enlarge rapidly, outpacing the rest of the body’s growth in the first year of life. Superficial hemangiomas appear as bright red, flat or raised patches on the skin, while deep ones growing below the surface may be more difficult to detect. Both types are usually compressable to the touch. They most often grow in the head or neck area, but they can involve any part of the body, including major organs. Their size is variable and while most patients only have one lesion, multiple hemangiomas can occur. After infancy, they slowly begin to regress and usually fully disappear by the time the child is 5 to 7 years old.
“Ninety percent of hemangiomas are not harmful during infancy,” says Arin Greene, MD, MMSc, plastic surgeon in the Vascular Anomalies Center. “The other 10 percent may ulcerate or obstruct vital structures, such as the eyes or throat. Although hemangiomas regress in early childhood, approximately one-half of patients will have residual fibrofatty tissue, redundant skin, scarring or destruction of anatomical structures that might require operative correction.”
Most hemangiomas are easily identified without any diagnostic testing. Deeper lesions may require an ultrasound or MRI to confirm the diagnosis or to evaluate the extent of the hemangioma.
Although the majority of hemangiomas are small and non-problematic, the primary care pediatrician should monitor the lesion and contact a specialist if the tumor is located in a difficult anatomical position or ulcerates or obstructs vision, hearing or breathing. Also, if a child has multiple hemangiomas, he is at greater risk for internal lesions and should be referred to a specialist. Because children may have a residual deformity following involution of the hemangioma, many are referred to a plastic surgeon to discuss reconstructive options.
While hemangiomas may look alarming, Dr. Greene states that most should just be watched closely. For the 10 percent of patients who have problems, such as eye obstruction or a large ulceration, corticosteroids are the first-line treatment, Dr. Greene says. “Steroids are safe and effective. Almost all patients will respond and the hemangioma will stop growing with proper dosing.“ For small hemangiomas, steroids can be injected directly into the lesion, but for larger ones, oral steroids may be required. Although hemangiomas may not become immediately smaller with these treatments, they will be prevented from growing any larger.
Some institutions have started treating hemangiomas with the beta blocker propranolol; however, its effectiveness and risks compared to corticosteroid have not been studied. To find out more, Children’s Vascular Anomalies Center is currently recruiting patients for a prospective, randomized trail to determine the safety and efficacy of propranolol versus corticosteroid.
For the 50 percent of children who have damaged skin or residual fibrofatty tissue after the hemangioma involutes, itís best to refer them to a plastic surgeon in early childhood to discuss reconstructive options, especially if the lesion is located on the face.
Research by Joyce Bischoff, PhD, research associate in Childrenís Vascular Biology Program, is revealing some causes of infantile hemangioma. Her research indicates that hemangioma growth may be due to an in utero mutation in a stem cell destined to become an endothelial cell. The mutation then causes the endothelial cells to multiply at an abnormal rate leading to the hemangioma. Dr. Bischoff and colleagues are currently working to identify potential medication to target this cell, thereby halting the growth or preventing its enlargement altogether.
Make a referral or learn about the clinical trial: 617-355-5226 or childrenshospital.org/vac
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