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Lesion Morphology in Multifocal Infantile Hemangiomas
Antonia Reimer1, Peter H Hoeger1
1Department of Pediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
Background/Objectives:
Multifocal infantile hemangiomas (MIHs; previously called neonatal hemangiomatosis) can be associated with extracutaneous hemangiomas. We observed different morphologic types of hemangiomas in children with MIHs and sought to find out whether they are related to the clinical course.
Methods:
This was a retrospective study of 103 infants with MIHs and a control group of 261 age-matched patients with solitary focal infantile hemangiomas (IHs) seen at an academic pediatric dermatology department between 2004 and 2014.
Results:
Two morphologic subtypes of hemangiomas were identified: miliary focal hemangiomas (MFHs; small, lens shaped) in 58 of 103 MIH patients (56.3%), and classical nonmiliary focal IHs (NMIHs; larger, irregularly shaped) in 17 of 103 patients (16.5%). MIHs featuring both types (mixed type) were observed in 28 of 103 patients (27.2%). MFH lesions were significantly smaller (mean 5.3 mm [range 1-20 mm] vs 22.0 mm [range 2-100 mm]), more numerous (23.4 ± 27.3 [range 5-175] vs 7.4 ± 2.8 [range 5-15] p < 0.001), and occurred up to an older age (6.0 ± 5.8 months [range 0-27 months] vs 3.8 ± 2.6 months [range 0-9 months]) than NMIHs. There was a weakly positive correlation between the number and presence of extracutaneous IHs in children with MFHs. Significantly more children with MIHs were delivered preterm than those with solitary IHs.
Conclusions:
The number of IHs correlates inversely with their size. MFHs follow a clinical course different from that of classical IHs, are associated with prematurity, and may confer greater risk of extracutaneous hemangiomas. Miliary hemangiomas thus appear to present a separate IH subset requiring special attention.
Insights
Miliary focal hemangiomas (MFHs) are smaller, more numerous, and appear later than classical infantile hemangiomas (IHs). MFHs are linked to prematurity and a higher risk of extracutaneous hemangiomas, suggesting they are a distinct subtype.
Area of Science:
- Pediatric Dermatology
- Vascular Anomalies
- Neonatal Care
Background:
- Multifocal infantile hemangiomas (MIHs) can present with extracutaneous involvement.
- Morphologic variations within MIHs may influence clinical presentation and outcomes.
- Understanding these variations is crucial for appropriate patient management.
Purpose of the Study:
- To investigate the relationship between different morphologic types of infantile hemangiomas (IHs) in children with MIHs and their clinical course.
- To differentiate between miliary focal hemangiomas (MFHs) and classical nonmiliary focal IHs (NMIHs).
- To identify potential risk factors and clinical associations of MFHs.
Main Methods:
- Retrospective study of 103 infants with MIHs and 261 controls with solitary IHs.
- Classification of hemangiomas into miliary focal (MFH), nonmiliary focal (NMIH), and mixed types.
- Comparison of lesion size, number, age of occurrence, and association with prematurity and extracutaneous hemangiomas.
Main Results:
- Two subtypes identified: MFHs (56.3%) and NMIHs (16.5%), with mixed types in 27.2%.
- MFH lesions were smaller, more numerous, and occurred at a later age compared to NMIHs.
- MFHs showed a weak correlation with extracutaneous IHs and were significantly associated with preterm delivery.
Conclusions:
- Miliary focal hemangiomas represent a distinct subset of IHs with unique clinical characteristics.
- MFHs are associated with prematurity and potentially increased risk of extracutaneous hemangiomas.
- The number of IHs correlates inversely with their size, highlighting differences between MFHs and NMIHs.
