Hemangioma medical therapy

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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]

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.[1]

Medical Therapy

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

Intense pulsed light

  • IPL flash lamps emit broadband polychromatic high-intensity light in the wavelength spectrum ranging 515-1200nm.[3]
  • They target vessels at various depths inside the skin.
  • The effect relies on selective photothermolysis.
  • The indication spectrum includes vascular tumors including hemangiomas.

Propranolol

  • A paradigm shift has occurred regarding the treatment of hemangiomas over the past few years.[2]
  • Propranolol, a nonselective β-adrenergic antagonist, was serendipitously 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.[2]

References

  1. 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#
  2. 2.0 2.1 2.2 2.3 2.4 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.
  3. Caucanas, Marie; Paquet, Philippe; Henry, Frédérique; Piérard-Franchimont, Claudine; Reginster, Marie-Annick; Piérard, Gérald E. (2011). "Intense Pulsed-Light Therapy for Proliferative Haemangiomas of Infancy". Case Reports in Dermatological Medicine. 2011: 1–5. doi:10.1155/2011/253607. ISSN 2090-6463.

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