Infantile Hemangioma: An Updated Review

Area of Science:

• Pediatric Dermatology
• Vascular Biology
• Infant Health

Background:

• Infantile hemangiomas (IHs) are the most common vascular tumors in infants, affecting up to 12% of this population.
• IHs typically appear after birth, growing rapidly in the first few months and involuting over several years.

Purpose of the Study:

• To provide physicians with comprehensive information on the natural history, clinical presentation, diagnosis, and management of IHs.
• To review current treatment strategies and indications for intervention in infantile hemangiomas.

Main Methods:

• A systematic literature search was performed on PubMed using the term "infantile hemangioma".
• Included studies published in English within the last 20 years, encompassing meta-analyses, RCTs, clinical trials, observational studies, and reviews.

Main Results:

• IHs usually appear weeks after birth, grow rapidly until 9-12 months, and involute significantly by age 5-12 years.
• About 50% resolve by age 5, with 95% regressing by age 10-12.
• Most IHs do not require treatment; indications for intervention include hemorrhage, vital structure interference, or significant disfigurement.

Conclusions:

• Treatment decisions for IHs must be individualized based on lesion characteristics, complications, patient factors, and physician expertise.
• Oral propranolol is the preferred treatment for high-risk or complicated IHs.
• Topical timolol is an alternative for superficial IHs or patients at risk of adverse events from oral propranolol.