The term hemangioma refers to a tumor due to the proliferation of endothelial cells that characteristically has an initial proliferative phase that is followed by a slow involution phase. Most are not present at birth, and this feature can help differentiate them from congenital hemangiomas, which are considered a different entity and do not have the same natural history.
What are The Types of Hemangioma?
There are basically three types of hemangiomas that can appear in babies: capillary hemangiomas, which are red and are on the surface of the skin, the cavernous hemangiomas, which are blue and are found in the deeper layers of the skin, and mixed hemangiomas, which present characteristics of both types.
Vascular anomalies are divided into tumors or malformations. Hemangiomas fall within the group of tumors, and it is important to differentiate them from congenital hemangiomas. Congenital hemangiomas are completely formed at birth and have a rapid involution, or do not involute at all, so they are known as congenital hemangiomas of rapid involution or congenital hemangiomas that do not involute (RICH and NICH, for its acronym in English).
Infantile hemangiomas are classified as superficial, deep or mixed depending on their extension. Other terms accepted to classify hemangiomas describe the morphological subtype or its stage.
Around 10 to 20% of HI, due to that its location and/or complications can cause serious aesthetic, functional consequences or even vital, and these are the ones that require more aggressive interventions. In general, those tumors that affect areas of risk of giving functional complications (eyelids, the tip of the nose, lips or air), those that are a great size and cause heart failure or disfigurement, and ulcerated hemangiomas, are which usually decides to treat.
The most frequent complications associated with infantile hemangiomas are ulcerations, infections and those related to the functionality of the organ where the injury.
Ulceration
This is the most frequent complication that has been reported in around 15% of the hemangiomas. Ulcerations are most commonly observed during the proliferative phase and the Most are located in friction sites, at the genital, cervical or perioral levels. The deleterious effects of ulcerations include irritability, pain, secondary infection, and hemorrhage, as well as permanent scars and disfigurement. The treatment of ulcerations is related to the management of wounds: the use of protective barriers such as petrolatum, zinc oxide, is recommended.
Topical antibiotics and dressings- Pain management must be aggressive, especially when handling injuries, such as with changing dressings and during the cleaning of them. It is recommended to keep ulcerated areas under occlusion, give oral analgesia with acetaminophen, ibuprofen or codeine and in severe cases, the use of lasers.
Periocular Hemangiomas
The hemangiomas located on the eyelids they can produce ptosis, strabismus, and anisometropia.
The final result of an untreated hemangioma that obstructs the visual field is amblyopia by deprivation, secondary to shaft obstruction visual. In children less than 2 years, 2 weeks of Visual deprivation can lead to visual deficit permanent cortical and this is what it is about prevented with early interventions. The medical treatment in these cases should be systemic and management should be carried out jointly with an ophthalmologist, to prevent permanent visual loss.
Hepatic Hemangiomas
Hepatic hemangiomas have been reported as a single finding or associated with multiple skin hemangiomas. They are classified in this way in focal, multifocal and diffuse.
Diffuse hepatic hemangiomas also can lead to hypothyroidism. Treatment should be started with steroids at high doses, as well as replacement hormone therapy required for the patient. Cases have been reported associated with infantile hemangioma that has required up to 3 times the dose commonly used for the treatment of congenital hypothyroidism.
Hemangiomas in the Airway
In the HI located at mandibular and neck level called “beard distribution”, it should be considering the presence of them at the level of the airway. There may be cases of hemangiomas in the airway without any cutaneous findings. These injuries can produce respiratory symptoms such as stridor and respiratory distress. Most, 83% respond to systemic treatment, with few cases requiring a tracheostomy. However, a laryngoscopy should be performed in cases of hemangiomas located in this distribution and in cases of clinical suspicion.
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