Hemangioma medical therapy: Difference between revisions

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{{Hemangioma}}
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==Overview==
The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically.
==Medical Therapy==
==Medical Therapy==
*Most hemangiomas disappear without treatment, leaving minimal or no visible marks.  
* Medical and surgical options are available for the treatment of “problematic” hemangiomas.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref><ref name="epidemiology">Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#</ref>
 
* Medical management includes one or more systemic therapies.
*Large hemangiomas can leave visible skin changes secondary to severe stretching of the skin or damage to surface texture.  
* For massive and life-threatening disease:<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
 
**[[Corticosteroids]]
*When hemangiomas interfere with vision, breathing, or threaten significant cosmetic injury, they are usually treated.
** [[Interferon]]
 
** [[Vincristine]]
*Ulceration will usually heal with topical medication and special dressings under medical supervision.
* These agents have also been used for:<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
 
** Multifocal disease
====Corticosteroids====
** Visceral involvement
The mainstay of treatment is oral [[corticosteroid]] therapy.  
** Segmental distribution
 
** Airway obstruction
Smaller raised lesions are sometimes treated with injection of [[corticosteroid]] directly into the lesion.  
** Periorbital lesions
 
===Propranolol===
====Other drugs====
*A paradigm shift has occurred regarding the treatment of hemangiomas over the past few years.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
Other drugs such as [[interferon]] or [[vincristine]] are sometimes considered if the corticosteroids do not work.
*Propranolol, a nonselective [[Β-2 adrenergic receptor|β-adrenergic antagonist]], was serendipitous discovered to cause regression of proliferating hemangiomas in newborns receiving treatment for cardiovascular disease.
*Numerous studies demonstrating the success of [[propranolol]] for shrinking hemangiomas
*Over ninety percent of patients have dramatic reduction in the size of their hemangiomas as early as 1-2 weeks following the first dose of [[propranolol]].
*Dosing for [[propranolol]] in treating hemangiomas is recommended to be 2-3 mg/kg separated into two or three-times-a-day regimens.
*These doses are dramatically below the concentration employed for cardiovascular conditions in children.<ref name="RichterFriedman2012">{{cite journal|last1=Richter|first1=Gresham T.|last2=Friedman|first2=Adva B.|title=Hemangiomas and Vascular Malformations: Current Theory and Management|journal=International Journal of Pediatrics|volume=2012|year=2012|pages=1–10|issn=1687-9740|doi=10.1155/2012/645678}}</ref>
'''Pediatric/Infantile hemangioma in proliferative phase:'''
*Oral regimen
** Preferred regimen (1): [[Propranolol]] 0.5 mL/kg PO q12h for 7 days;
*** [[Propranolol]] 0.3 mL/kg PO q12h for 7 days;
*** [[Propranolol]] 0.4 mL/kg PO q12h for 6 months
'''Beyond proliferative phase'''
*Oral regimen
** Preferred regimen (1): [[Propranolol]] 1.5-3 mg/kg/day PO for 8 months.<ref name="pmid21362031">{{cite journal |vauthors=Zvulunov A, McCuaig C, Frieden IJ, Mancini AJ, Puttgen KB, Dohil M, Fischer G, Powell J, Cohen B, Ben Amitai D |title=Oral propranolol therapy for infantile hemangiomas beyond the proliferation phase: a multicenter retrospective study |journal=Pediatr Dermatol |volume=28 |issue=2 |pages=94–8 |date=2011 |pmid=21362031 |doi=10.1111/j.1525-1470.2010.01379.x |url=}}</ref>


==References==
==References==
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{{Reflist|2}}
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Latest revision as of 22:01, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]Amandeep Singh M.D.[3]

Overview

The majority of cases of hemangioma are self-limited. Patients with small, stable hemangiomas in non-vital sites are treated with "wait and see" approach, whereas patients with fast growth of hemangioma are treated medically.

Medical Therapy

  • Medical and surgical options are available for the treatment of “problematic” hemangiomas.[1][2]
  • Medical management includes one or more systemic therapies.
  • For massive and life-threatening disease:[1]
  • These agents have also been used for:[1]
    • Multifocal disease
    • Visceral involvement
    • Segmental distribution
    • Airway obstruction
    • Periorbital lesions

Propranolol

  • A paradigm shift has occurred regarding the treatment of hemangiomas over the past few years.[1]
  • Propranolol, a nonselective β-adrenergic antagonist, was serendipitous discovered to cause regression of proliferating hemangiomas in newborns receiving treatment for cardiovascular disease.
  • Numerous studies demonstrating the success of propranolol for shrinking hemangiomas
  • Over ninety percent of patients have dramatic reduction in the size of their hemangiomas as early as 1-2 weeks following the first dose of propranolol.
  • Dosing for propranolol in treating hemangiomas is recommended to be 2-3 mg/kg separated into two or three-times-a-day regimens.
  • These doses are dramatically below the concentration employed for cardiovascular conditions in children.[1]

Pediatric/Infantile hemangioma in proliferative phase:

Beyond proliferative phase

  • Oral regimen
    • Preferred regimen (1): Propranolol 1.5-3 mg/kg/day PO for 8 months.[3]

References

  1. 1.0 1.1 1.2 1.3 1.4 Richter, Gresham T.; Friedman, Adva B. (2012). "Hemangiomas and Vascular Malformations: Current Theory and Management". International Journal of Pediatrics. 2012: 1–10. doi:10.1155/2012/645678. ISSN 1687-9740.
  2. Zheng JW, Zhang L, Zhou Q, et al. A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med. 2013;6(10):851-60.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322/?report=classic#
  3. Zvulunov A, McCuaig C, Frieden IJ, Mancini AJ, Puttgen KB, Dohil M, Fischer G, Powell J, Cohen B, Ben Amitai D (2011). "Oral propranolol therapy for infantile hemangiomas beyond the proliferation phase: a multicenter retrospective study". Pediatr Dermatol. 28 (2): 94–8. doi:10.1111/j.1525-1470.2010.01379.x. PMID 21362031.

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