Infantile Hemangioma

Abstract

Infantile hemangiomas typically appear in the first few weeks of life as areas of pallor,
followed by telangiectatic patches. They then grow rapidly in the first 3 to 6 months of life.
Superficial lesions are bright red, protuberant, and sharply demarcated and are often referred
to as “strawberry hemangiomas”. Deep lesions are bluish and dome-shaped, feel like a “bag
of worms”, and are compressible. Infantile hemangiomas have a predilection for the head and
neck region. Most infantile hemangiomas exist as solitary lesions. Infantile hemangiomas continue
to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel
the growth of the child. Half of these lesions will show complete involution by the time a child
reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by ages 10 to
12. The majority of infantile hemangiomas require no treatment. Indications for active intervention
include severe or recurrent hemorrhage unresponsive to treatment, threatening ulceration in
areas where serious complications might ensue, interference with vital structures, pedunculated
hemangiomas, and significant disfigurement. Treatment options include systemic corticosteroids,
intralesional corticosteroids, topical and oral beta blockers, pulsed-dye laser, and less commonly
interferon-α or surgical resection. In recent years, propranolol, a nonselective β-blocker,
has been preferentially used as a first-line treatment of problematic infantile hemangioma.