Infantile hemangiomas.
Current treatment procedures

Czech version

Authors: J. Mališ ¹; V. Stará ²; K. Bláhová ²; H. Bučková ³; R. Faberová ³; J. Štěrba ⁴; S. Klovrzová ⁵; M. Kynčl ⁶; Michal Černý ⁷; R. Hrdlička ⁸; M. Mojžíšová ⁹; M. Vaculík ¹⁰; J. Kozák ¹⁰; R. Katra ¹¹; I. Michalusová ¹²; A. Sukop ¹³; M. Rygl ¹⁴; J. Hercogová ¹⁵; P. Arenberger ¹⁶; R. Šmucler ¹⁷; Š. Čapková ¹⁸
Authors‘ workplace: Klinika dětské hematologie a onkologie 2. LF UK a FN Motol, Praha ¹; Pediatrická klinika 2. LF UK a FN Motol, Praha ²; Dětské kožní oddělení Pediatrické kliniky FN Brno ³; Klinika dětské onkologie LF MU a FN Brno ⁴; Nemocniční lékárna FN Motol, Praha ⁵; Klinika zobrazovacích metod 2. LF UK a FN Motol, Praha ⁶; Novorozenecké oddělení Gynekologicko-porodnické kliniky 2. LF UK a FN Motol, Praha ⁷; Dětské oddělení nemocnice, Kolín ⁸; Dětské oddělení nemocnice, Hořovice ⁹; Neurochirurgická klinika dětí a dospělých 2. LF UK a FN Motol, Praha ¹⁰; Klinika ušní, nosní a krční 2. LF UK a FN Motol, Praha ¹¹; Stomatologická klinika dětí a dospělých 2. LF UK a FN Motol, Praha ¹²; Klinika plastické chirurgie 3. LF UK a FN Královské Vinohrady, Praha ¹³; Klinika dětské chirurgie 2. LF UK a FN Motol, Praha ¹⁴; Dermatovenerologická klinika 2. LF UK a Nemocnice Na Bulovce, Praha ¹⁵; Dermatovenerologická klinika 3. LF UK a FN Královské Vinohrady, Praha ¹⁶; Asklepion, Praha ¹⁷; Dermatologické oddělení pro děti, FN Motol, Praha ¹⁸
Published in: Čes-slov Pediat 2017; 72 (4): 245-254.
Category:

Overview

Infantile hemangiomas are the most common benign tumors that affect between 10–12% of infants, a higher incidence in premature and immature children. There are three basic types – superficial, deep and mixed. Most hemangiomas do not require any treatment, stagnation and involution occur after the phase of intense growth in the first 4 to 5 months of life. About half of the hemangiomas persist in more or less significant residues. Around 10% of hemangiomas can cause serious complications – endangering vital functions (eyelid, nose, etc.), exudation, bleeding and severe cosmetic impairment. The first-line drug is the non-selective betablocker propranolol administered at a dose of 2–3 mg/kg/day for 6 months. Propranolol acts as a vasoconstrictor of capillary hemangiomas, blocking vascular endothelial growth factor (VEGF) promoting vascular development and promoting apoptosis (natural death of vascular cells). Propranolol induces involution of hemangioma and residues after treatment are significantly lower and less severe. The most common complications are sleep disorder (up to 20% of children). Treatment should be performed in centers where a pediatric dermatologist, oncologist, cardiologist, radiologist, and surgeon are provided with the appropriate specializations to resolve residual lesions.

KEY WORDS:
hemangioma, infantile hemangioma, propranolol

Sources

1. Munden A, Butschek R, Tom WL, et al. Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies. Br J Dermatol 2014; 170: 907–913.

2. Goelz R, Poets CF. Incidence and treatment of infantile haemangioma in preterm infants. Arch Dis Child Fetal Neonatal Ed 2015; 100: F85–91.

3. International Society for the Study of Vascular Anomalies. ISSVA classification of vascular anomalies. 2014. Available at: issva.org/classification. Accessed April 2015.

4. Drolet BA, Frieden IJ. Characteristics of infantile hemangiomas as clues to pathogenesis: does hypoxia connect the dots. Arch Dermatol 2010; 146: 1295–1299.

5. Baselga E, Roe E, Coulie J, et al. Risk factors for degree and type of sequelae after involution of untreated hemangiomas of infancy. JAMA Dermatol 2016 Nov 1; 152 (11): 1239–1243.

6. Leaute-Labreze C, Prey S, Ezzedine K. Infantile haemangioma: Part I. Pathophysiology, epidemiology, clinical features, life cycle and associated structural abnormalities. J Eur Acad Dermatol Venereol 2011; 25: 1245–1260.

7. Horii KA, Drolet BA, Frieden IJ, et al. Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas. Pediatr Dermatol 2011; 28: 245–253.

8. Vredenborg AD, Janmohamed SR, de Laat PCJ, et al. Multiple cutaneous infantile haemangiomas and the risk of internal haemangioma. Br J Dermatol 2013; 169: 188–191.

9. Metry DW, Haggstrom AN, Drolet BA, et al. A prospective study of PHACE syndrome in infantile hemangiomas: demographic features, clinical findings, and complications. Am J Med Genet A 2006; 140: 975–986.

10. Metry DW, Dowd CF, Barkovich AJ, Frieden IJ. The many faces of PHACE syndrome. J Pediatr 2001; 139 (1): 117–123.

11. Girard C, Bigorre M, Guillot B, Bessis D. PELVIS syndrome. Arch Dermatol 2006; 142 (7): 884–888.

12. Haggstrom AN, Drolet BA, Baselga E, et al. Prospective study of infantile hemangomas: clinical characteristics predicting complications and treatment. Pediatrics 2006; 118: 882–887.

13. Horii KA, Drolet BA, Frieden IJ, et al. Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas. Pediatr Dermatol 2011; 28: 245–253.

14. Vredenborg AD, Janmohamed SR, de Laat PCJ, et al. Multiple cutaneous infantile haemangiomas and the risk of internal haemangioma. Br J Dermatol 2013; 169: 188–191.

15. Krenova Z, Kren L, Blatny J, et al. Extraosseal Ewing sarcoma as a rare cause of the blueberry muffin baby syndrome: a case report and the review of the literature. Am J Dermatopathol 2011 Oct; 33 (7): 733–735.

16. Chamlin SL,Mancini AJ, Lai JS, et al. Development and validation of a quality-of-life instrument for infantile hemangioma. J Invest Dermatol 2015; 135 (6): 1533–1539.

17. Léaute-Labrèze C, Boccara O. Safety of oral Propranolol for the treatment of infantile hemangioma: A systematic review. Pediatrics 2016 Oct; 138 (4): 1–19.

18. Baselga E, et al. Spanish consensus on infantile haemangioma. An Pediatr 2016; 85: 256–265.

19. Léauté-Labrèze C. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008; 358 (24): 2649–2651.

20. Hermans DJ, Bauland CG, Zweegers J, et al. Propranolol in a case series of 174 patients with complicated infantile haemangioma: indications, safety and future directions. Br J Dermatol 2013; 168: 837–843.

21. Mališ J. Hemangiomy kojenců. Čes Dermatovenerol 2014; 4 (1): 8–14.

22. Puttgen KB. Multifocal infantile hepatic hemangiomas—imaging strategy and response to treatment after propranolol and steroids including review of the literature. Eur J Pediatr 2012; 171: 1023–1028.

23. Xu SQ, Jia RB, Zhang W, et al. Beta-blockers versus corticosteroids in the treatment of infantile hemangioma: an evidence-based systematic review. World J Pediatr 2013 Aug; 9 (3): 221–229.

24. Mališ J, Stará V, et al. Betablokátory v léčbě hemangiomů dětského věku. Čes-slov Pediat 2014; 69 (5): 274–282.

25. Blei F, McElhinney DB, Guarini A, Presti S. Cardiac screening in infants with infantile hemangiomas before propranolol treatment. Pediatr Dermatol 2014; 31 (4): 465–470.

26. Léauté-Labrèze C, Hoeger P, et al. A randomized controlled trial of oral propranolol in infantile hemangioma. N Engl J Med 2015; 372:735–746.

27. Marqueling AL, Oza V, Frieden IJ, Puttgen KB. Propranolol and infantile hemangiomas four years later: a systematic review. Pediatr Dermatol 2013; 30: 182–191.

28. Léauté-Labrèze C, Harper JI, Hoeger PH. Infantile haemangioma. Published: 12 January 2017. DOI: http://dx.doi.org/10.1016/S0140-6736(16)00645-0

29. McMahon P, Oza V, Frieden IJ. Topical timolol for infantile hemangiomas: putting a note of caution in „cautiously optimistic“. Pediatr Dermatol 2012; 29: 127–130.

30. Qiu Y, Ma G, Yang J, et al. Imiquimod 5% cream versus timolol 0.5% ophthalmic solution for treating superfi cial proliferating infantile haemangiomas: a retrospective study. Clin Exp Dermatol 2013; 38: 845–850.

31. Chinnadurai S, Sathe NA, Surawicz T. Laser treatment of infantile hemangioma: A systematic review. Lasers Surg Med 2016 Mar; 48 (3): 221–233. doi: 10.1002/lsm.22455.

32. Šmucler R. Cévní anomálie u dětí. Betablokátory? Kdy? Lasery? Jaké? Referátový výběr z dermatovenerologie. Remedia 2015; 57 (6): 18–22. ISSN: 1213 9106.

33. Baselga E, Roe E, Coulie J, et al. Risk Factors for Degree and Type of Sequelae After Involution of Untreated Hemangiomas of Infancy. JAMA Dermatol. doi:10.1001/jamadermatol.2016.2905 Published online August 17, 2016.

34. Kurta AO, Dai D, Armbrecht ES, Siegfried EC: Prescribing propranolol for infantile hemangioma: Assessment of dosing errors. J Am Acad Dermatol 2017 May; 76 (5): 999-1000.