II. Epidemiology

  1. Prevalence: 1.1 - 2.6% of all newborns (10% of infants at one year)
  2. More common in Premature Infants

III. Signs

  1. Often lesion not present at birth or barely noticeable pale patch of skin
  2. Distribution
    1. Midline
    2. Beard region
  3. Erythematous or violaceous lobulated lesions

IV. Differential Diagnosis

  1. Thrombocytopenia
  2. Cardiac failure
  3. Cutaneous Signs of Spinal Dysraphism (e.g. sacral Hemangioma)

V. Associated Conditions

  1. Kasabach-Merritt Syndrome
  2. Tethered Cord with lumbosacral lesions
    1. See Cutaneous Signs of Spinal Dysraphism

VI. Course

  1. Develops in first four weeks after birth
  2. Proliferates until 9 to 12 months of age
  3. Spontaneous Resolution
    1. Age 5 years: 50% resolution
    2. Age 7 years: 70% resolution
    3. Age 9 years: 90% resolution
  4. Residual atrophy, Hypopigmentation, Telangiectases, or scarring may occur

VII. Management: First-Line

  1. Propranolol
    1. FDA approved for age 5 weeks and older
    2. Well tolerated and very effective at facilitating Hemangioma involution when used in the first year of life
    3. Start in first months of life to prevent proliferation and continue for 6 months
    4. Dose: 1 mg/kg orally twice daily
      1. Give dose after feeding to prevent Hypoglycemia
      2. May be increased up to 2-3 mg/kg twice daily if needed
    5. References
      1. Léauté-Labrèze (2015) N Engl J Med 372(8):735-46 +PMID: 25693013 [PubMed]

VIII. Management: Refractory (Interventions by Pediatric Dermatology)

  1. Compression garment or Coban Tape
    1. Hemangiomas on arms or legs
  2. Biosynthetic dressing every 24 hours
  3. Prednisone
    1. Indicated where Hemangioma compresses eye, airway or other vital conditions
    2. Dose: 3 mg/kg daily for 6-12 weeks
    3. Continue until lesion stops growing or size decreases
  4. Interferon alfa (if refractory to Steroids)
  5. Sirolimus
  6. Topical Timolol Maleate
  7. Pulsed-dye laser therapy

IX. Management: Indications for referral or further evaluation

  1. Multiple Hemangiomas
    1. Consider Ultrasound of the Abdomen to evaluate for gastrointestinal and Liver Lesions
  2. Deep Hemangiomas
  3. Large Hemangiomas
    1. Risk of high-output Heart Failure
  4. Sacral Hemangiomas
    1. See Cutaneous Signs of Spinal Dysraphism
  5. Airway Hemangioma
    1. May present with Stridor
    2. Airway Hemangiomas tend to enlarge through the first year of life
  6. Eyelid Hemangioma
    1. May block Vision

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