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Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas
Kimberly A Horii1, Beth A Drolet, Ilona J Frieden
1Section of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA. kahorii@cmh.edu
Insights
Infants with five or more cutaneous infantile hemangiomas have a higher incidence of hepatic hemangiomas. This supports screening infants with numerous skin hemangiomas for liver involvement, though most cases do not require treatment.
Area of Science:
- Pediatric Dermatology
- Hepatology
- Medical Imaging
Background:
- Multiple cutaneous infantile hemangiomas are often linked to hepatic hemangiomas.
- Screening infants with numerous skin hemangiomas using abdominal ultrasound is a common recommendation.
Purpose of the Study:
- To determine the frequency of hepatic hemangiomas in infants with five or more cutaneous infantile hemangiomas compared to those with fewer.
- To characterize the clinical features of hepatic hemangiomas in this cohort.
Main Methods:
- A multicenter prospective study involving pediatric dermatology clinics.
- Abdominal ultrasonography was performed on infants younger than 6 months with varying numbers of cutaneous infantile hemangiomas.
Main Results:
- Sixteen percent (24/151) of infants with five or more cutaneous infantile hemangiomas had hepatic hemangiomas, versus none in the group with fewer than five (p = 0.003).
- Only two infants with hepatic hemangiomas required specific treatment.
Conclusions:
- A threshold of five or more cutaneous infantile hemangiomas supports screening for hepatic hemangiomas in infants under 6 months.
- The majority of infants identified with hepatic hemangiomas through screening do not necessitate treatment.
Abstract:
Multiple cutaneous infantile hemangiomas have been associated with hepatic hemangiomas. Screening of infants with five or more cutaneous infantile hemangiomas with abdominal ultrasound is often recommended. The aim of this study was to determine the frequency with which hepatic hemangiomas occur in infants with five or more cutaneous infantile hemangiomas compared to those with one to four cutaneous infantile hemangiomas and to characterize the clinical features of these hepatic hemangiomas. A multicenter prospective study of children with cutaneous infantile hemangiomas was conducted at pediatric dermatology clinics at Hemangioma Investigator Groups sites in the United States, Canada, and Spain between October 2005 and December 2008. Data were collected, and abdominal ultrasonography was performed on infants younger than 6 months old with five or more cutaneous infantile hemangiomas and those with one to four cutaneous infantile hemangiomas. Twenty-four (16%) of the 151 infants with five or more cutaneous infantile hemangiomas had hepatic hemangiomas identified on abdominal ultrasound, versus none of the infants with fewer than five (p = 0.003). Two of the 24 infants with hepatic hemangiomas received treatment specifically for their hepatic hemangiomas. Infants with five or more cutaneous infantile hemangiomas have a statistically significantly greater frequency of hepatic hemangiomas than those with fewer than 5. These findings support the recommendation of five or more cutaneous infantile hemangiomas as a threshold for screening infants younger than 6 months old for hepatic hemangiomas but also demonstrate that the large majority of these infants with hepatic hemangiomas do not require treatment.
