Evaluation of Clinical Properties and Treatment Responses of Infantile Hemangioma
December 2020 | Volume 19 | Issue 12 | Original Article | 1156 | Copyright © December 2020
Published online November 28, 2020
Didem Yildirimcakar MD, Ugur Demirsoy MD, Mehmet Azizoglu MD, Funda Corapcioglu Prof
Department of Pediatric Oncology, Kocaeli University School of Medicine, Kocaeli, Turkey
Infantile hemangiomas are the most common vascular tumors in childhood. Although spontaneous regression is common; several infantile hemangioma patients need treatment due to possible morbidities. The aim of this study was to investigate the medical methods used in the treatment of infantile hemangiomas and to evaluate the factors affecting treatment response. Methods:
Clinical and demographic characteristics, risk factors, treatment indications, modalities, duration, and responses of 100 patients between January 2007 and January 2017 were evaluated. Results:
The most common form of hemangiomas was superficial lesions. Sixty three per cent of the patients were female. Ulceration and hemorrhage were found in 26% of the cases and ocular problems were detected in 3% of the cases. Among the indications for treatment were cosmetic reasons with 56%, ulcer and bleeding with 25% and risk of vision problems with 13%. Propranolol with/without steroid was used as first line treatment and response rates were: 84 patients with more than 50% response, 9 patients with less than 50% response and 7 patients with treatment refractory. The most important factor affecting the treatment response was age at the beginning of the treatment. Duration of treatment, presence of ulceration, location, and size of hemangioma were also found to have significant effects on responses. Conclusions:
This study demonstrated the importance of the kind and initiation time of infantile hemangioma treatment. A strong positive effect can be reached by starting treatment before the end of the proliferation phase. J Drugs Dermatol.
Infantile hemangiomas (IH) are the most common benign vascular tumors of infancy.1 Prevalence in childhood varies between 1–10%.2 Most IH can be followed without treatment, but treatment may be necessary due to several complications such as feeding and respiratory difficulties, visual disturbance, heart failure, ulceration of the lesion, and bleeding.1
In this study, we aimed to evaluate the clinical features, treatment modalities, and treatment-related characteristics of IH treated in our hospital.
Patients admitted to Kocaeli University Department of Pediatric Oncology between January 2007 and January 2017 with hemangioma were retrospectively evaluated. The study was approved by the Kocaeli University Clinical Research Ethics Committee. Inclusion criteria were lesions compatible with the definition of IH, under the age of 18 years, treatment was initiated with diagnosis of IH, patients diagnosed and treated at our center, and patients followed up for at least 6 months after discontinuation of treatment.
Exclusion criteria were diagnoses other than IH (including congenital hemangioma), patients with missing information on diagnosis and treatment in their files, and patients who did not complete the 6-month period after the end of treatment.
Treatment indications were presence of one or more of the criteria in category A in Table 1, and when these criteria were unmet, two or more criteria in category B were needed.3-9
We determined 150 IH patients whose records could be reached. 20 patients had no indication for treatment, 3 patients’ diagnoses were changed to congenital hemangioma after clinical reanalysis, and 27 patients were not followed after the first admission. Therefore, the study group consisted of 100 patients fulfilling the inclusion criteria. The patients were evaluated in terms of gender, age at which the lesions were recognized, presence of precursor lesion at birth, location, type, size, number, and complications.
The age at which the lesions were detected were grouped as ‘0–1 months’, ‘2–6 months’, and ‘above 6 months’. The term ‘IH’ was used for lesions that came up as a precursor lesion at birth with progressive growth afterwards, while ‘congenital hemangioma’ was used for lesions that completed their proliferation at birth or did not grow further.