Peds
Hemangioma
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Hemangioma
, Capillary Hemangioma, Strawberry Hemangioma, Infantile Hemangioma
See Also
Newborn Skin Exam
Epidemiology
Prevalence
: 1.1 - 2.6% of all newborns (10% of infants at one year)
More common in
Premature Infant
s
Signs
Often lesion not present at birth or barely noticeable pale patch of skin
Distribution
Midline
Beard region
Erythematous or violaceous lobulated lesions
Differential Diagnosis
Thrombocytopenia
Cardiac failure
Cutaneous Signs of Spinal Dysraphism
(e.g. sacral Hemangioma)
Associated Conditions
Kasabach-Merritt Syndrome
Tethered Cord
with lumbosacral lesions
See
Cutaneous Signs of Spinal Dysraphism
Course
Develops in first four weeks after birth
Proliferates until 9 to 12 months of age
Spontaneous Resolution
Age 5 years: 50% resolution
Age 7 years: 70% resolution
Age 9 years: 90% resolution
Residual atrophy,
Hypopigmentation
,
Telangiectases
, or scarring may occur
Management
First-Line
Propranolol
FDA approved for age 5 weeks and older
Well tolerated and very effective at facilitating Hemangioma involution when used in the first year of life
Start in first months of life to prevent proliferation and continue for 6 months
Dose: 1 mg/kg orally twice daily
Give dose after feeding to prevent
Hypoglycemia
May be increased up to 2-3 mg/kg twice daily if needed
References
Léauté-Labrèze (2015) N Engl J Med 372(8):735-46 +PMID: 25693013 [PubMed]
Management
Refractory (Interventions by Pediatric Dermatology)
Compression garment or Coban Tape
Hemangiomas on arms or legs
Biosynthetic dressing every 24 hours
Prednisone
Indicated where Hemangioma compresses eye, airway or other vital conditions
Dose: 3 mg/kg daily for 6-12 weeks
Continue until lesion stops growing or size decreases
Interferon alfa
(if refractory to Steroids)
Sirolimus
Topical
Timolol
Maleate
Pulse
d-dye laser therapy
Management
Indications for referral or further evaluation
Multiple Hemangiomas
Consider
Ultrasound
of the
Abdomen
to evaluate for gastrointestinal and
Liver Lesion
s
Deep Hemangiomas
Large Hemangiomas
Risk of high-output
Heart Failure
Sacral Hemangiomas
See
Cutaneous Signs of Spinal Dysraphism
Airway Hemangioma
May present with
Stridor
Airway Hemangiomas tend to enlarge through the first year of life
Eyelid Hemangioma
May block
Vision
References
McLaughlin (2008) Am Fam Physician 77: 56-60 [PubMed]
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