Are Hemangiomas Painful?
In most cases, hemangiomas do not cause pain, but it is the contrary in other patients. A hemangioma can be sensitive to pressure if it appears in a wrinkle or in the armpits. If you suffer from chafing in these areas, especially in the case of rapidly growing hemangiomas, other associated symptoms may occur such as bleeding, pain or inflammation of the affected skin.
There are several controversial aspects in the management of hemangiomas. It is pathology with a low incidence, of variable evolution, hardly predictable. There are currently five main objectives in terms of the management:
- Prevent or treat complications with organic or vital commitment.
- Prevent permanent dysmorphia.
- Minimize the psychosocial impact on the patient and the family.
- Avoid aggressive and potentially scarring procedures.
- Prevent or treat ulceration to minimize scars, infections, and pain.
In general, there is no doubt about treating so-called “alarming hemangiomas” (those that imply a life-threatening situation or to the function of nearby organs), which account for approximately 10 to 20% of the total of hemangiomas. On the other hand, there are hemangiomas that do not represent a threat a priori, and in these cases, questions arise about which is the most appropriate attitude. Those who advocate aggressive management postulate that this minimizes risks, while those who advocate conservative management believe that better cosmetic results are achieved since most hemangiomas are self-limiting. We can then speak of two clearly different attitudes, the expectant attitude, and the medical or surgical therapeutic attitude.
The detractors of this attitude maintain that, after reaching its maximum involution, around 25% of the hemangiomas present a significant deformity. This attitude could be indicated in small hemangiomas, located far from areas with possible functional damage, and with a slow growth rate.
The treatments are divided into non-specific (surgery, cryotherapy), antiangiogenic (corticosteroids, interferon) and antiproliferative (chemotherapy, radiotherapy).
Hemangiomas that obstruct the visual axis, the airway, the auditory canal and the anogenital region (with alteration of visual, respiratory, swallowing, intestinal or urinary function) should be submitted to treatment; those with rapid growth that produce or may produce significant tissue destruction or disfigurement, as well as widespread skin lesions or visceral involvement that may lead to congestive heart failure, severe bleeding or coagulation disorders. The psychological impact of the injury on the patient and family members should also be considered. Any therapeutic attitude must be preceded by an informed consent. The treatment must be early since they present a rapid growth in the first weeks of life.
Corticosteroids are for many authors the treatment of choice in potentially problematic hemangiomas and constitute the most effective monotherapy treatment in common hemangiomas.
The intralesional administration of corticosteroids is an effective treatment that manages to avoid the adverse effects of systemic corticosteroids. They are indicated in well-localized cutaneous hemangiomas, mainly in the auricular pavilion, nasal tip, cheeks, eyelids, and lips.
Topical clobetasol has been used with good response and absence of adverse effects, but with inferior results to those found with intralesional corticosteroids.
In the treatment of hemangiomas, IFN alfa 2 and subsequently beta 2 have been used successfully, appreciating that they stop the growth and favor the decrease in size, even with greater potency than corticosteroids.
Although cytotoxic drugs are traditionally used in malignant diseases, they are sometimes administered in biologically benign diseases with potentially serious complications, such as some hemangiomas.
Intralesional bleomycin has been used successfully in a series of 14 hemangiomas, with fibrosis and spontaneous resolution of the lesions after 2 or 3 treatments with 2 mg bleomycin separated 30 days. It is also effective in painful hemangiomas and ulcerated hemangiomas.
Ulceration occurs in 10% of hemangiomas and is the most frequent complication. Usually occurs in places exposed to trauma, and occurs during the proliferation phase, so it should not be interpreted as a sign of the involution. It is associated with significant pain, bleeding, secondary super infection, and residual scar.