Vascular lesions in infants and children are classified mainly into two groups: Tumors and Vascular Malformations.
Infantile hemangiomas are found within the group of benign tumors. However, childhood hemangiomas are the most common vascular tumors.
Do Hemangiomas Go Away?
Hemangiomas may take many years to go away on their own. Hemangiomas go through a series of phases in which it is evidenced a proliferation stage, which consists of a very rapid growth for the first 12 months of life, then it is slower but finally there is a spontaneous involution consisting on a decrease of the tumor size, a complete remission might be achieved if it is properly treated.
Infantile hemangiomas are characterized by having a phase of growth, stability, and involution; in contrast to vascular malformations that are made up of anomalous capillaries, arteries, veins, and lymphatic vessels and grow proportionally to the child’s growth, usually without involute.
There are other rare hemangiomas with a rapid involution (RICH) or non-involving hemangiomas (NICH); other than infantile hemangiomas.
The majority of childhood hemangiomas are not clinically evident at birth, but in the first days to weeks of life.
In many cases it is found a premonitory injury, which is a violet plate or with telangiectasias (a condition characterized by dilation of the capillaries, which causes them to appear as small red or purple clusters, often spidery in appearance).
Generally, the lesions are unique, although in 20% of cases there may be multiple. They can appear on any part of the skin, mucous membranes, even internal organs such as the intestine or liver, but they usually appear on the head and neck. The clinical aspect depends on the location and depth; from according to their depth they are classified in:
Superficial (most common): Papule or reddish nodule on the clinically normal skin.
Deep: Subcutaneous nodules of bluish tonality with central telangiectasias.
Mixed: With clinical features both superficial and deep. According to their location, they can be classified as:
Localized: The most common, usually on the face near the middle line.
Segmentary: Generally, it affects a specific cutaneous territory without passing midline and requires a more intensive and prolonged treatment compared to localized hemangiomas. In addition, they can be associated with syndromes such as PHACES and LUMBAR.
Infantile hemangiomas have three phases:
Proliferation phase consisting of a stage of rapid growth during the first 5 months of life, in which 80% of its final size grows, and from the 6th to 12th month the slow growth phase occurs. Proliferation after one year of life may occur, but it is rare.
A phase of stability or plateau in which the hemangioma stops proliferating, it can be overcome with the slow growth phase.
Spontaneous involution phase that typically begins at one year of age and continues through the years, it is estimated that the size of the hemangioma decreases.
Differential Diagnoses for Hemangiomas
Segmental infantile hemangiomas in the face can be confused early with a capillary malformation or wine stain of segmental port (associated or not to Sturge-Weber syndrome). One important difference is that the capillary malformation will not proliferate nor involute.
They can also be confused with a pyogenic granuloma; however, the age of onset and the clinical course of these are very different. By last, it can be confused with other uncommon vascular tumors such as kaposiform hemangioendothelioma, tuft angioma, and RICH or NICH.
The most common complication is ulceration, infantile hemangioma should be suspected in rapid proliferation, with a change in coloration before three months, and if they are located in points of friction and maceration. There may be infection or bleeding as a result of the ulceration.
Childhood hemangiomas localized at cervicofacial, mandibular or distributed “in beard form” are at risk of airway obstruction, which should be suspected in patients that develop stridor or progressive dysphonia, cough or cyanosis.
Periorbital infantile hemangiomas confer risk of visual field obstruction during its proliferation and astigmatism phase by the pressure exerted on the cornea. The evaluation by ophthalmology is a priority since it could have permanent damage, even blindness.
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