Infantile hemangioma. Part 2: Management

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 ...

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Bibliographic Details
Published in:	Journal of the American Academy of Dermatology Vol. 85; no. 6; pp. 1395 - 1404
Main Authors:	Sebaratnam, Deshan F., Rodríguez Bandera, Ana l., Wong, Li-Chuen F., Wargon, Orli
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-12-2021
Subjects:	Adrenergic beta-Antagonists - therapeutic use COVID-19 hemangioma Hemangioma, Capillary - drug therapy Hemangioma, Capillary - pathology Humans Infant laser nevus Nevus - drug therapy Nevus - pathology Pandemics pediatric dermatology propranolol Propranolol - therapeutic use SARS-CoV-2 Skin Neoplasms - drug therapy Skin Neoplasms - pathology Timolol - therapeutic use Treatment Outcome vascular malformation hemangioma nevus PHACES laser pediatric dermatology propranolol PDL vascular malformation IH
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Summary:	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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	0190-9622 1097-6787
DOI:	10.1016/j.jaad.2021.08.020