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The changing face of complicated infantile hemangioma treatment
Deanna Menapace1,2, Mario Mitkov1, Richard Towbin3
1Phoenix Regional Campus, Creighton University School of Medicine, Phoenix, AZ, USA.
Insights
Infantile hemangiomas, common vascular tumors, are best managed with a multidisciplinary team. Propranolol is the primary treatment, but interventions are needed for complex cases.
Area of Science:
- Pediatric Dermatology
- Vascular Biology
- Medical Imaging
Background:
- Infantile hemangiomas (IHs) are the most frequent vascular tumors in infants.
- Management of IHs requires a collaborative approach involving multiple specialists.
- Propranolol, introduced in 2008, is now the standard first-line therapy for IHs.
Purpose of the Study:
- To review the updated 2014 International Society for the Study of Vascular Anomalies (ISSVA) classification.
- To provide management algorithms for complicated infantile hemangiomas.
- To outline indications for interventional and surgical management.
Main Methods:
- Review of the 2014 ISSVA classification for vascular anomalies.
- Development of management algorithms for complex IH cases.
- Synthesis of current treatment strategies including medical, radiologic, and surgical options.
Main Results:
- The 2014 ISSVA classification provides updated criteria for vascular anomalies.
- Propranolol has largely replaced corticosteroids and radiologic interventions as first-line treatment.
- Specific algorithms are proposed for managing complicated IH lesions requiring intervention.
Conclusions:
- A multidisciplinary team is essential for managing complicated infantile hemangiomas.
- While propranolol is the primary treatment, interventional strategies remain important for specific indications.
- Updated classification and management algorithms aid in optimizing patient care for infantile hemangiomas.
Abstract:
Infantile hemangiomas are the most common vascular tumors of infancy. A multidisciplinary approach including dermatologists, otolaryngologists, plastic surgeons, hematologists/oncologists and interventional/diagnostic radiologists is crucial for appropriate management of children with complicated infantile hemangiomas. Since its unforeseen discovery in 2008, propranolol has become the first-line treatment for infantile hemangiomas, eclipsing systemic corticosteroids and radiologic intervention. There are still, however, uncommon indications for more aggressive interventional management. We review the 2014-updated International Society for the Study of Vascular Anomalies (ISSVA) classification for vascular anomalies. Additionally, we suggest management algorithms for complicated lesions, including recommendations for radiologic and surgical intervention.
