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Infantile Hemangiomas
Hemangiomas are birthmarks consisting of an abnormal, dense group of blood vessels in one place on the body, usually on the head and neck. Although the cause of such birthmarks are unknown, it is believed to form from certain proteins produced in the placenta during gestation[1.0]. Hemangiomas are very common and occur in 10% of the world’s population [2]. Infantile Hemangiomas (IH) usually form in infants 2-3 weeks after birth. Furthermore, their growth escalates during 5-7 weeks after birth.[1.1]Previous studies have identified prematurity, low birth weight, female gender, Caucasian race, twin births, and advanced maternal age as risk factors associated with IH development. [3]
The different types of IH include superficial hemangiomas, deep hemangiomas, and mixed hemangiomas. The three types of hemangiomas can exist as capillary, cavernous, or compound hemangiomas; the most common type is the capillary hemangioma.
Capillary hemangioma:
Capillary hemangioma is the most common type of hemangioma. It is made up of small capillaries normal in size and diameter, but high in density. The capillaries form a tightly-packed network held together by thin, connective tissue. Capillary hemangiomas are typically bright red in color, due to their close proximity to the skin’s surface. They vary in size and may be flat to the skin, raised, or protrude out as a nodule. In some cases, they appear as spongy masses that cover an entire extremity (called "diffuse hemangioma" or "angiomatosis"). Capillary hemangiomas are generally referred to as “superficial.” [4.0]
Capillary Hemangioma
Image credit: Don Kikkawa MD [7]
Cavernous hemangioma:
In contrast with a capillary hemangioma, a cavernous hemangioma is made up of larger blood vessels that are dilated. The blood vessels are not as closely packed and the spaces (or "caverns") between them are filled with blood. They appear as bluish swelling underneath the skin or show signs of telangiectasia, due to their further proximity to the skin’s surface. Cavernous hemangiomas also vary in size and can occur throughout the body. Cavernous hemangiomas are generally called “deep” hemangiomas.[4.1]
Cavernous Hemangioma [8] [9]
Compound hemangioma:
Compound hemangiomas are a mix of the capillary and cavernous types. Therefore, they can be both “superficial” and “deep.” [4.2]
TREATMENTS
Strict observation is recommended to monitor any changes in hemangiomas throughout the patient’s life. Beta Blocker medications are used to hinder the growth of the lesion in capillary hemangiomas; they are taken orally for at least 6 months before the patient turns one years old. Anti-inflammatory medications (eg: steroids) are used for hemangiomas forming near vital human structures such as the nose, lips, or eyelids. Steroids delay tumor growth and are administered orally or by injection. Intermittent pneumatic compression uses inflatable sleeves or leggings to apply pressure to the tumor, which can decrease the swelling associated with the hemangioma. However, this treatment does not eliminate the tumor. Embolization is a minimally invasive procedure used to cut the blood supply to the tumor by injecting small particles into the blood vessels to block them off. Similarly, in Sclerotherapy, chemical agents are used to close off the vessels. Both procedures are helpful in shrinking the tumor and decreasing possible pain. However, these procedures are only temporary solutions because the tumors may grow. Lastly, laser treatment can be helpful in removing a hemangioma, priming a tumor for other treatments, or decreasing pain and other unwanted symptoms. Multiple laser treatments may be needed depending on the size and location of the hemangioma.[4.3]
Additionally, each procedure has its own risk profile as well. Steroid use comes with a plethora of side effects such as cushingoid facies (called “moon faces”), weight fluctuation, irritability, fussiness, insomnia, hypertension, and hyperpigmentation.[5]Possible side effects of Sclerotherapy include hyperpigmentation, short-term burning pain, telangiectatic matting, skin necrosis, ulceration, thrombophlebitis, pulmonary embolism or accidental arterial injection.[6]
Article References:
- ↑[1.0][1.1]Khan, April. “Hemangioma.” Healthline, Healthline Media, 27 Sept. 2019, www.healthline.com/health/hemangioma.
- ↑ Richter, Gresham T., and Adva B. Friedman. “Hemangiomas and Vascular Malformations: Current Theory and Management.” International Journal of Pediatrics, Hindawi, 7 May 2012, www.hindawi.com/journals/ijpedi/2012/645678/.
- ↑ Munden, A, et al. “Prospective Study of Infantile Haemangiomas: Incidence, Clinical Characteristics and Association with Placental Anomalies.” The British Journal of Dermatology, U.S. National Library of Medicine, Apr. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4410180/.
- ↑[4.0][4.1][4.2][4.3]“Hemangioma - OrthoInfo - AAOS.” OrthoInfo, orthoinfo.aaos.org/en/diseases--conditions/hemangioma.
- ↑ Sethuraman, Gomathy, et al. “Management of Infantile Hemangiomas: Current Trends.” Journal of Cutaneous and Aesthetic Surgery, Medknow Publications & Media Pvt Ltd, Apr. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4134656/.
- ↑ Grover, Chander, et al. “Sclerotherapy for the Treatment of Infantile Hemangiomas.” Journal of Cutaneous and Aesthetic Surgery, Medknow Publications & Media Pvt Ltd, July 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3483580/.
Image References
- ↑ “Capillary Hemangioma.” EyeWiki, 14 Oct. 2020, eyewiki.org/Capillary_Hemangioma.
- ↑ “Deep (Cavernous) Hemangioma.” consultant360.Com, Volume 45, May 2005, www.consultant360.com/articles/deep-cavernous-hemangioma-0.
- ↑ “Cavernous Hemangioma.” Wikipedia, Wikimedia Foundation, 19 Oct. 2020, en.wikipedia.org/wiki/Cavernous_hemangioma.
