II. Epidemiology
- Prevalence: 1.1 - 2.6% of all newborns (10% of infants at one year)
- More common in Premature Infants
III. Signs
- Often lesion not present at birth or barely noticeable pale patch of skin
- Distribution
- Midline
- Beard region
- Erythematous or violaceous lobulated lesions
IV. Differential Diagnosis
- Thrombocytopenia
- Cardiac failure
- Cutaneous Signs of Spinal Dysraphism (e.g. sacral Hemangioma)
V. Associated Conditions
- Kasabach-Merritt Syndrome
- Tethered Cord with lumbosacral lesions
VI. 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
VII. 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
VIII. 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
- Pulsed-dye laser therapy
IX. Management: Indications for referral or further evaluation
- Multiple Hemangiomas
- Consider Ultrasound of the Abdomen to evaluate for gastrointestinal and Liver Lesions
- Deep Hemangiomas
- Large Hemangiomas
- Risk of high-output Heart Failure
- Sacral Hemangiomas
- Airway Hemangioma
- May present with Stridor
- Airway Hemangiomas tend to enlarge through the first year of life
- Eyelid Hemangioma
- May block Vision