Early Intervention Effects and Risk Factors for Residual Skin Changes in Infantile Hemangiomas

Infantile hemangioma (IH) characteristically progresses through proliferative, involuting, and involuted phases, and typically undergoes spontaneous regression after the age of five. Therefore, the traditional management strategy has been based on a "wait-and-see policy". However, the degree and tempo of proliferation vary considerably among individuals, and rapid enlargement can lead to functional impairment or ulceration. Moreover, in some cases, significant residual skin changes may persist even after involution. In Japan, pulsed dye laser (PDL) therapy was approved for insurance coverage in 1996, and early intervention during the proliferative phase has since become the standard approach to prevent such complications. At our institution, we have also actively implemented early PDL therapy, with oral propranolol added in selected cases. We conducted a retrospective analysis of 92 patients with 107 IH lesions who initiated PDL therapy at our dermatology department between January 2014 and December 2022. Earlier initiation of laser treatment was significantly associated with an earlier peak in tumor size (r = 0.80, p < 0.0001). Furthermore, evaluation of residual skin changes after treatment completion revealed that the nodular type exhibited significantly more severe residual skin changes than the other morphological subtypes (Fisher's exact test, p < 0.0001). A peak size ≥ 3 cm² was also identified as a risk factor for severe residual skin changes (multivariate logistic regression analysis, odds ratio 21.6, 95% confidence interval 2.93-358, p = 0.0090). In contrast, low birth weight and prematurity were not associated with an increased risk of severe residual skin changes when laser treatment was initiated. In conclusion, early PDL initiation was associated with earlier peak lesion size in IHs. Nodular-type lesions and peak size ≥ 3 cm² predicted severe long-term residual skin changes, supporting early risk stratification and timely consideration of systemic therapy in high-risk cases.