[Angioma in childhood: current criteria for therapy]

After examining the most recent literature on this subject, the authors assess the state of the art of current knowledge regarding cutaneous angioma in the light of their personal experience. The histological, biological and clinical characteristics are analysed and enable a new nosographic evaluation of this frequent pathology which must be differentiated from vascular malformations. In the light of these unique features, the authors examine the current forms of treatment for angioma using local, systemic or physical therapy. Cutaneous angioma may be present at birth or may appear during the first months of life, occasionally regressing spontaneously up until the child is seven years old. They also present a population of proliferating endothelial cells. This explains the possibility that these neoformations will spontaneously regress, an event that must be taken into account before commercing therapy. With regard to their diagnosis valuable information is provided by telethermography, ultrasonography, Doppler scan and CAT. If an angioma is present from the first weeks of life, a wait-and-see policy should be adopted unless the lesion is localised in an orbital, mammary, palpebral, subglottic, nasal or labial region. Local therapy of angioma using sclerosant substances is now controversial; the best results are obtained using periodical administrations of triamcinolone acetonide or betamethasone. Systemic treatment with prednisone is indicated in forms localised on the orbita where interlesional injections are frequently followed by complications such as hematoma and infections. Systemic treatment requires an interdisciplinary approach, especially in pediatrics, due to the repercussions which the use of high dose conrticosteroids provokes on hormone function in children. The use of alpha interferon with discordant results has recently been reported in the literature. In superficial forms physical therapy may be more appropriate. Cryotherapy provoked a lesion caused by cold: an ionic alteration of tissues through freezing leads to necrosis. Plesiotherapy has been now virtually abandoned due to the risks of growing tissue. In terms of therapy and application there has been a widespread increase in the use of argon laser over the past years: the "Tunable Dye Laser" present unique characteristics which allow the wave length to be modulated in relation to the colour and depth of the lesion to be treated, causing selective photothermolysis. Encouraging results can be obtained by subjecting immature angioma to applications every 3-4 weeks using an every of 7-8 J/cm2. The use of the tunable dye laser is, however, preferable in superficial angioma. Compressive therapy using elastic bandages or specially made garments is effective only in those localisation where it is possible to obtain compression, like limbs and the parotid region. From the above comments it can be seen that the treatment of immature angioma is extremely complex due to their clinical and evolutive variability. It is therefore vital to following the rules laid down by experience: waiting for the involution of the angioma, even if it is commonly observed event, is often difficult to achieve due to the scarce collaboration of parents. Moreover, it is important to achieve a close interdisciplinary collaboration between pediatrician, dermatologist and plastic surgeon.