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Prognostic Factors for Long-term Aesthetic Outcome of Infantile Haemangioma Treated with Beta-blockers
Mireille M Hermans1, Suzanne G M A Pasmans2, Marlies De Graaf3
1Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, The Netherlands.
Insights
Long-term outcomes for infantile haemangioma treated with beta-blockers depend on lesion characteristics and treatment details. Superficial components, ulceration, and older treatment initiation age negatively impact aesthetic results.
Area of Science:
- Pediatric Dermatology
- Vascular Anomalies
- Pharmacology
Background:
- Infantile haemangioma (IH) treatment with beta-blockers raises parental concerns about long-term aesthetic outcomes.
- Understanding factors influencing IH's long-term appearance is crucial for managing expectations and optimizing treatment.
Purpose of the Study:
- To assess the influence of IH characteristics, beta-blocker treatment parameters, and infant factors on long-term aesthetic outcomes.
- To provide data for parental counseling and guide treatment strategies for IH.
Main Methods:
- Cross-sectional study of 103 children (aged 6-12 years) treated for IH in infancy with beta-blockers (propranolol or atenolol).
- Assessment using Patient Observer Scar Assessment Scale (POSAS) by dermatologists and parents, and visual analogue scale (VAS) by children.
- Dermatologists evaluated for telangiectasia, fibrofatty tissue, and atrophic scarring.
Main Results:
- Negative aesthetic outcomes were associated with superficial IH components, ulceration, older age at treatment initiation, higher cumulative beta-blocker dose, and shorter follow-up.
- Children perceived better aesthetic outcomes for IH located on the head compared to other sites.
Conclusions:
- Close monitoring of IH, especially superficial types, is vital for timely treatment initiation and ulceration prevention/management.
- Treatment strategies and parental counseling should consider factors identified as negatively impacting long-term aesthetic results.
Abstract:
Parents of infants treated with beta-blockers for infantile haemangioma are often concerned about the long-term aesthetic outcome. This cross-sectional study assessed the influence on the long-term aesthetic outcome of characteristics of the infantile haemangioma, the beta-blocker treatment, and the infant. The study included 103 children aged 6-12 years, treated with beta-blockers (propranolol or atenolol) for infantile haemangioma during infancy (age at treatment initiation ≤1 year) for ≥6 months. Dermatologists and parents scored the Patient Observer Scar Assessment Scale, and the child scored a visual analogue scale. Dermatologists identified whether telangiectasia, fibrofatty tissue, and atrophic scar tissue were present. The long-term aesthetic outcome of infantile haemangioma was judged more negatively by dermatologists and parents in case of a superficial component, ulceration, older age at treatment initiation, higher cumulative dose, and/or shorter follow-up time. According to children, infantile haemangioma located on the head had better aesthetic outcome than infantile haemangioma located elsewhere. Close monitoring, particularly of infantile haemangioma with a superficial component, is essential for early initiation of treatment, and to prevent or treat ulceration. These outcome data can support parental counselling and guide treatment strategy.
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