Infantile Hemangiomas

These are by far the most common type of hemangioma and resemble most closely the classic “strawberry birthmark” you may have seen or heard of. They are occasionally present at birth but most commonly do not become noticeable until about 2 weeks to 2 months after birth. While there are many theories out there regarding the cause of hemangiomas, the simple answer is that we do not know what causes hemangiomas; at least, not yet. We do know that they are more common among Caucasian females of low-birth weight.

Infantile hemangiomas tend to occur more commonly on the head and neck area. The skin is by far the organ most commonly involved, so most of these lesions are readily identifiable. If the hemangioma is located near a vital organ such as the airway or the eye, a much more aggressive treatment approach is sought so as to prevent problems with organ and functional development. Infantile hemangiomas can also involve the organs inside the body such as the liver, intestines, or the airway occasionally in conjunction with a hemangioma of the skin. These are much more difficult to identify and diagnose and can sometimes be an incidental discovery. Most, not all, internal hemangiomas tend to be problematic and are treated aggressively.

Regardless of location and severity of symptoms, true infantile hemangiomas have a characteristic and predictable pattern of presentation and regression. They are typically identified around 2 weeks to 2 months after birth and grow until about 12 months of age. This growth period is called the “proliferation phase”. Thereafter, they undergo a long, drawn-out n involution phase which occurs from about 12 months of age and can last until about adolescence and the pre-pubertal period. This period is termed the “involution period”. From there on out, there is continued remodeling and scarring of the residual components of the hemangioma. This period is called the “involuted period”.

The key component in management of any infantile hemangioma is early referral and evaluation at a dedicated center of excellence with a multidisciplinary approach. Earlier intervention can minimize and correct potentially serious problems during the proliferation phase (such as visual, respiratory, or digestive problems). It has also been effective at reducing the need for extensive surgery late in the involution or involuted periods. It also minimizes the inherent psychosocial complications associated with a disfiguring, readily apparent lesion.

Available treatment options include simple observation, pharmacotherapy (steroids, beta-blockers, and/or immunomodulators), surgical excision with reconstruction, laser therapy, and rarely catheter-directed techniques such as angiography with or without embolization (injection of different types of particles directly into the problematic area in order to eliminate or reduce its blood supply). Often, a combination of these techniques is required for optimal results.

Congenital Hemangiomas

These are much rarer hemangiomas and have a different pattern of presentation than the classic infantile hemangiomas. They have a predilection for the upper trunk and the extremities (arms and legs). Unlike infantile hemangiomas, they are present at birth (congenital) and either undergo rapid (within 6-12 months) regression (termed rapidly involuting congenital hemangioma or RICH) or do not regress at all (termed non-involuting congenital hemangiomas or NICH). Treatment for these is variable depending on location and associated symptomatology. Similar to infantile hemangiomas, early referral to a dedicated center of excellence is key in eliminating or minimizing associated complication.

Kaposiform Hemangioendothelioma / Tufted Angioma

These are extremely rare hemangiomas that have a much more aggressive pattern of growth and can invade multiple tissue planes or layers of the body. Given their aggressive nature, they can be associated with consumption of the body’s own inherent clotting mechanisms and can lead to potentially serious and sometimes lethal bleeding and clotting complications. This serious complication is termed Kasabach-Merritt Phenomenon – a condition that deserves immediate medical attention. Again, we emphasize early referral to and evaluation by a dedicated center of excellence so as to minimize potentially lethal consequences.

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