Hemangiomas of Infancy
Hemangiomas of Infancy are the most common vascular tumors in infants. These benign lesions usually have an initial phase of rapid growth from the first 6 to 8 months of life and after this they start to involute by themselves. One third of the hemangiomas will resolve by 3 year of age, one third by 6 years of age and the last third by 9 years of age. By the end of their involution these tumors can leave a faint mark or scar in the area were they were localized or a residual amount of superficial blood vessels. Depending on the body area they can have a medical significance for treatment or no treatment. Most of them grow in areas that do not interfere with other organs or cause disfigurement and just require observation by the doctor; but a small amount of them, for example, can grow in areas that interfere with vision (eyelids), breathing or eating (throat), ulcerate in mucosal areas (lips, diaper area, neck), cause disfigurement by interfering with regular formation of cartilage (nose and ears) or compromise the heart work due to its large size or multiple lesions. The majority of them don’t require medical treatment; but if required, they will include oral medications such as propanolol or prednisone, pulsed dye laser, Nd YAG laser, Co2 laser or surgical excision depending on the clinical evaluation.
A NICH or non-involuting congenital hemangioma is a rare growth of blood vessels that is completely formed at birth. A NICH looks like a round or oval shaped mass that is pink to blue/violet in color with the lesion usually being warmer than the surrounding skin. NICHs are often seen on the face, head and neck and grow rapidly along with the infant in the first 6 months to one year of life. After a plateau in growth, an NICH will not shrink quickly in later years, hence non-involuting. Treatment options for NICHs include surgical removal and pulsed dye laser therapy(?).
A RICH or rapidly involuting congenital hemangioma is a rare growth of blood vessels that is completely formed at birth. A RICH looks more plaque-like (flat) than a NICH and is pink to purple in color. RICHs are often seen on the face, head and neck with most RICHs shrinking completely within the first year of life, hence rapidly involuting. Treatment options for RICHs include surgical removal, pulsed dye laser therapy and use of becaplermin gel.
PHACES syndrome is a term used to describe a special type of hemangioma that usually covers a segmental area of the body and is associated with other anomalies that include malformations in the posterior area of the brain, cerebral or neck blood vessels anomalies, cardiac anomalies, eye abnormalities and sternum or abdominal clefting. When a patient is found to have a hemangioma that covers a special area of the body this type of syndrome is suspected and studies that include magnetic resonance, echocardiogram and ultrasound are performed to rule out any of these conditions.
PELVIS syndrome is used for the association of lumbosacral or genital area hemangiomas associated with malformation of the external genitalia, urinary tract abnormalities (kidneys and bladder), malformations of the end of the spinal cord (lipomyelomeningocele) and abnormalities of the anus (imperforation or tags).
Pyogenic granuloma is a relatively common skin growth that presents as a shiny red mass. It is sometimes called ‘granuloma telangiectaticum’. The surface has a raspberry-like or raw minced meat appearance. Although they are benign (non-cancerous), pyogenic granulomas can cause problems of discomfort and profuse bleeding. Pyogenic granuloma may be secondary to trauma, infection (Staphylococcus auerus common) hormonal changes (occurs in 5% of pregnancies) drug induced (acitretin isotretinion or protease inhibitors). Lesions usually first appear as a small pinhead-sized red, brownish-red or blue-black spot that grows rapidly over a period of a few days to weeks to anywhere between 2mm and 2cm in diameter. They bled and can ulcerate forming crusted sores. They mostly appear on the head, neck upper trunk, hands and feet. They usually go away after a pregnancy and some treatment options are: curettage/cauterization (lesion is scrapped with a curette and then cauterized to reduce the blood vessels and chances of regrowth), pulsed dye laser and cryosurgery (liquid nitrogen).
Gorham syndrome is a rare condition involving gradual bone loss that can affect one or more bones. The cause is unknown and clinical onset is from childhood to young adulthood. Associated symptoms include hemangiomas on one side of the body that can affect one or several contiguous bones, massive bone destruction, bone fibrosis, osteoporosis, fractures, and diffuse muscle atrophy. Superficial hemangiomas may not always be present. When the rib cage is involved, it is usually fatal.
Haggstrom AN, Drolet BA, Baselga E, et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr. Mar 2007;150(3):291-4.
Frieden IJ, Eichenfield LF, Esterly NB, Geronemus R, Mallory SB. Guidelines of care for hemangiomas of infancy. American Academy of Dermatology Guidelines/Outcomes Committee. J Am Acad Dermatol. Oct 1997;37(4):631-7.