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Infantile hemangioma. Part 2: Management
Deshan F Sebaratnam1, Ana L Rodríguez Bandera2, Li-Chuen F Wong2
1The Children's Hospital at Westmead, Sydney, Australia; Liverpool Hospital, Sydney, Australia.
Insights
Infantile hemangiomas (IH) are often managed conservatively. Propranolol has revolutionized IH treatment, with early specialist review and outpatient propranolol administration being key for optimal outcomes.
Area of Science:
- Dermatology
- Pediatric Medicine
- Pharmacology
Background:
- Infantile hemangiomas (IH) are common vascular tumors in infants.
- While many resolve spontaneously, some require intervention to prevent complications.
- Recent advancements have significantly improved IH management.
Purpose of the Study:
- To review current management strategies for infantile hemangiomas.
- To highlight the impact of propranolol on IH treatment.
- To discuss emerging therapies and diagnostic approaches for IH.
Main Methods:
- Literature review of recent studies on infantile hemangioma treatment.
- Analysis of clinical guidelines and expert recommendations.
- Discussion of pharmacological and procedural interventions.
Main Results:
- Propranolol is a revolutionary treatment for IH, often initiated outpatient at 1 mg/kg twice daily.
- Early specialist review (before 5 weeks) is crucial to prevent sequelae.
- Alternative treatments include corticosteroids, sirolimus, topical timolol, and laser therapy.
- Telemedicine is effective for IH diagnosis and management, with algorithms guiding remote care.
Conclusions:
- Propranolol has transformed infantile hemangioma management.
- Timely intervention and specialist care are vital for optimal outcomes.
- Telemedicine offers a viable approach for IH management, especially during pandemics.
Abstract:
The majority of infantile hemangiomas (IH) can be managed conservatively, but for those requiring active treatment, management has been revolutionized in the last decade by the discovery of propranolol. Patients that may require active intervention should receive specialist review, ideally before 5 weeks of age to mitigate the risk of sequelae. Propranolol can commence for most infants in the outpatient setting and the most frequently employed dosing regimen is 1 mg/kg twice daily. In the future, β-blockers with a more-selective mechanism of action, such as atenolol, show some promise. In recalcitrant lesions, systemic corticosteroids or sirolimus may be considered. For small, superficial IHs, topical timolol maleate or pulsed dye laser may be considered. Where the IH involutes with cutaneous sequelae, a range of interventions have been reported, including surgery, laser, and embolization. IHs have a well-described clinical trajectory and are readily diagnosed and managed via telemedicine. Algorithms have been constructed to stratify those patients who can be managed remotely from those who warrant in-person review during the COVID-19 pandemic.
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