Treating an infantile hemangioma

If your infant is born with an infantile hemangioma,  your pediatrician's initial response will be patience. Many hemangionas will go away without being treated. But it also important to understand that these tumors can act quite differently from individual to individual.

There are a few steps most infantile hemangiomas will take1:
• they will emerge as a blemish a few days after birth
• they will experience a period of rapid growth
• they will begin a very slow period of self-resolution sometime after a child's first birthday
• they will disappear sometime before the child's 10th birthday

Because the vast majority of infantile hemangiomas go away on their own, it is entirely possible that your pediatrician will recommend against treatment.

But there are cases when treatment for infantile hemangiomas is required. When the tumor occurs in a place where it can lead to longterm problems or disfigurement--  for example by placing pressure on developing eyes, or by blocking air passages -- a more aggressive approach is warranted.

A few treatment approaches are available:

Laser therapy for infantile hemangioma

A 2010 study out of China looked at the use of a kind of laser known as intense pulsed light (IPL) with optimal pulse technology (OPT) in treating 62 patients with hemangioma. The study involved giving the infants four or five treatments over four-week intervals, and the reserachers reported marked improvement in 76% of cases. There were some adverse events reported, but these were called "transient" in nature.2

While the Chinese study showed good results using new generation lasers, laser therapy in the United States has been shown to result in scarring, and a 2007 case report out of Philadelphia showed unexplained freckling 11-years after a patient completed laser therapy for a hemangioma.3

Steroids for infantile hemangioma

For many years, the first choice for physicians treating troublesome hemangiomas has been sterioids. However the safety and efficacy of using sterioids in infants has long been a topic of concern for many researchers. A study released just two months ago from researchers at Boston Children's Hospital found that oral steroids can, in fact, be a safe and effective treatment for infantile hemangiomas.4

The researchers noted, however, that "the efficacy of oral corticosteroid therapy for problematic infantile hemangioma depends on dosage, duration of treatment, and definition of therapeutic response." In the study, 88% of the patient's tumors regressed, and 12% stabilized. In  the study, therapy began on infants at about three months, and they were on full treatment until 10 months before being tapered off of the sterioids.4

Propranolol for infantile hemangioma

Propranolol is quickly becoming the first choice for pedatric dermatologists treating troublesome infantile hemangiomas. The drug is a beta blocker that historically has been used to treat tremors, angina (chest pain), hypertension (high blood pressure), heart rhythm disorders, and other heart or circulatory conditions. However, in 2008 the New England Journal of Medicine published an amazing piece from three doctors in France who recognized the potential for the drug to treat hemangiomas.5

Then, in August 2011, a confirmatory study appeared in Pediatrics that showed that propranolol was effective, not only in infants, but in children up to five years old. In fact, the conclusion was telling: "Propranolol hydrochloride administered orally at 2 mg/kg per day reduced the volume, color, and elevation of focal and segmental IH in infants younger than 6 months and children up to 5 years of age."6

It should be noted that the study stressed the importance of monitoring children placed in this cardiac drug, and that small children were admitted to receive their first doses. Additionally, researchers noted other adverse events including bronchiolitis, gastroenteritis, streptococcal infection, cool extremities, dental caries, and sleep disturbance.6

Conclusion

Infantile hemangiomas are the most common pediatric soft-tissue tumor. There is absolutely no shortage of parents dealing with the hard questions of what to do for their baby's tumor. There are therapy options available for tumors if aggressive treatment is warranted, and parents should educate themselves with all of their options so that they can make the best choice for their baby and their situation.

References

1. Gontijo B, Silva CMR, Pereira LB. Hemangioma da infância. An Bras Dermatol. 2003;78:651-73.

2.  Li DN, Gold MH, Sun ZS, Tang AR, Wang HB, Sheng-Kang L. Treatment of infantile hemangioma with optimal pulse technology. J Cosmet Laser Ther. 2010 Jun;12(3):145-50. Available at http://www.ncbi.nlm.nih.gov/pubmed/20482239.

3.  Bayliss SJ, Berk DR. Freckling 11 years after pulsed dye laser therapy for an infantile hemangioma: coincidence or a previously unrecognized complication? Clin Pediatr (Phila). 2008 Mar;47(2):189-90. Epub 2007 Dec 5.

4.  Greene AK, Couto RA. Oral prednisolone for infantile hemangioma: efficacy and safety using a standardized treatment protocol. Plast Reconstr Surg. 2011 Sep;128(3):743-52.

5. Léauté-Labrèze, Christine and de la Roque, Eric Dumas and Hubiche, Thomas and Boralevi, Franck and Thambo, Jean-Benoît and Taïeb, Alain. Propranolol for Severe Hemangiomas of Infancy. NEJM. 2008; 358(24): 2649-2651. Available at http://www.nejm.org/doi/full/10.1056/NEJMc0708819#t=article

6. Hogeling M, Adams S, Wargon O. A randomized controlled trial of propranolol for infantile hemangiomas. Pediatrics. 2011 Aug;128(2):e259-66. Epub 2011 Jul 25.