Clinical manifestation and management of hemangiomas of infancy

A retrospective study of hemangioma seen at the Pediatric Dermatology Clinic, Department of Pediatrics, Faculty of Medicine King Chulalongkorn Memorial Hospital from June 1991 to June 2000 was conducted. A total of 197 patients with 221 hemangiomas were followed-up from 6 months to 9 years. There were 134 girls and 63 boys (2.1:1), ranging in age from 6 months to 9 years. Twenty-two patients (11%) were premature neonates. Hemangiomas were presented at birth in 114 patients (58%), within the first month in 65 patients (33%), and after the age of 1 month in 18 patients (9%). Among the 197 patients, 18 patients (9%) had multiple locations. Types of hemangiomas were recorded as superficial, deep and combined in 84 (43%), 31 (16%) and 82 (41%), respectively. Head and neck were the most common sites of hemangiomas (65%), with 36 lesions (18%) on the trunk, 22 lesions (11%) on upper extremities, 22 lesions (11%) on lower extremities and 15 lesions (8%) on the perineum and buttock. Complications were found in 63 patients (32%) with 93 complications. Perineum and buttock had the highest rate of complication (60%), followed by the eyelid region (41%). Superficial hemangioma had the highest rate of complication (64%), followed by combined type (46%). Ulceration was the most common complication in the superficial and combined type. Obstruction was the most common complication in deep hemangioma. Management of hemangioma included observation, prednisolone, flashlamp-pumped pulsed-dye laser, topical therapy and excision in 68 per cent, 8.6 per cent, 10.7 per cent, 9.6 per cent, and 2.5 per cent, respectively. In conclusion, complications of hemangiomas are common. Close observation with regular follow-up will give better recognition and treatment of complications and associations.