Highlights & Basics
- Benign vascular lesions that typically appear during the first weeks of life as blue or pink macules or patches.
- Some lesions can be problematic, requiring identification and early treatment and/or referral.
- First-line therapy is systemic beta-blockers (such as propranolol).
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Definition
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Citations
Krowchuk DP, Frieden IJ, Mancini AJ, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019 Jan;143(1): e20183475.[Abstract][Full Text]
Darrow DH, Greene AK, Mancini AJ, et al. Diagnosis and management of infantile hemangioma. Pediatrics. 2015 Oct;136(4):e1060-104.[Abstract][Full Text]
Krowchuk DP, Frieden IJ, Mancini AJ, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019 Jan;143(1): e20183475.[Abstract][Full Text]
1. Krowchuk DP, Frieden IJ, Mancini AJ, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019 Jan;143(1): e20183475.[Abstract][Full Text]
2. Garzon MC. Infantile hemangioma. In: Callen JP, Horn TD, Mancini AJ, et al, eds. Dermatology. Vol. 2. 2nd ed. St. Louis, MO: Elsevier; 2008:1565-80.
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9. Goldberg NS, Hebert AA, Esterly NB. Sacral hemangioma and multiple congenital abnormalities. Arch Dermatol. 1986 Jun;122(6):684-7.[Abstract]
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12. Horii KA, Drolet BA, Frieden IJ, et al. Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas. Pediatr Dermatol. 2011 May-Jun;28(3):245-53.[Abstract]
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14. Darrow DH, Greene AK, Mancini AJ, et al. Diagnosis and management of infantile hemangioma. Pediatrics. 2015 Oct;136(4):e1060-104.[Abstract][Full Text]
15. Kilcline C, Friedan IJ. Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol. 2008 Mar-Apr;25(2):168-73.[Abstract]
16. Bruckner AL, Friedan IJ. Hemangiomas of infancy. J Am Acad Dermatol. 2003 Apr;48(4):477-93.[Abstract]
17. Drolet BA, Swanson EA, Frieden IJ, et al. Infantile hemangiomas: an emerging health issue linked to an increased rate of low birth weight infants. J Pediatr. 2008 Nov;153(5):712-5.[Abstract]
18. Smith CJF, Friedlander SF, Guma M, et al. Infantile hemangiomas: an updated review on risk factors, pathogenesis, and treatment. Birth Defects Res. 2017 Jul 3;109(11):809-15.[Abstract][Full Text]
19. Hemangioma Investigator Group, Haggstrom AN, Drolet, BA, et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr. 2007 Mar;150(3):291-4.[Abstract]
20. Barnes CM, Christison-Lagay EA, Folkman J. The placenta theory and the origin of infantile hemangioma. Lymphat Res Biol. 2007;5(4):245-55.[Abstract]
21. Pittman KM, Losken HW, Kleinman ME, et al. No evidence for maternal-fetal microchimerism in infantile hemangioma: a molecular genetic investigation. J Invest Dermatol. 2006 Nov;126(11):2533-8.[Abstract][Full Text]
22. Regnier S, Dupin N, Le Danff C, et al. Endothelial cells in infantile haemangiomas originate from the child and not from the mother (a fluorescence in situ hybridization-based study). Br J Dermatol. 2007 Jul;157(1):158-60.[Abstract]
23. Haggstrom AN, Drolet BA, Baselga E, et al. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics. 2006 Sep;118(3):882-7.[Abstract]
24. American College of Radiology. ACR appropriateness criteria: soft tissue vascular anomalies: vascular malformations and infantile vascular tumors (non-CNS)-child. 2023 [internet publication].[Full Text]
25. Paltiel HJ, Burrows PE, Kozakewich HP, et al. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology. 2000 Mar;214(3):747-54.[Abstract]
26. Kern S, Niemeyer C, Darge K, et al. Differentiation of vascular birthmarks by MR imaging. An investigation of hemangiomas, venous and lymphatic malformations. Acta Radiol. 2000 Sep;41(5):453-7.[Abstract]
27. Kitami M. Diffusion-weighted imaging as a routine MRI protocol for the evaluation of 'infantile hemangioma'. Clin Imaging. 2017 Nov - Dec;46:121.[Abstract]
28. Weedon D. Vascular tumors. In: Houston MJ, ed. Skin pathology. 2nd ed. New York, NY: Churchill Livingston; 2002:1001-43.
29. North PE, Waner M, Mizeracki A, et al. GLUT1: a newly discovered immunohistochemical marker for juvenile hemangioma. Hum Pathol. 2000 Jan;31(1):11-22.[Abstract]
30. Bree AF, Siegfried E, Sotelo-Avila C, et al. Infantile hemangioma: speculation on placental trophoblastic origin. Arch Dermatol. 2001 May;137(5):573-7.[Abstract][Full Text]
31. North PE, Waner M, James CA, et al. Congenital nonprogressive hemangioma: a distinct clinicopathological entity unlike infantile hemangioma. Arch Dermatol. 2001 Dec;137(12):1607-20.[Abstract][Full Text]
32. Metry DW, Dowd CF, Barkovich AJ, et al. The many faces of PHACE syndrome. J Pediatr. 2001 Jul;139(1):117-23. [Erratum in: J Pediatr 2001 Sep;139(3):470.][Abstract]
33. Legiehn GM, Heran MK. Venous malformations: classification, development, diagnosis, and interventional radiologic management. Radiol Clin North Am. 2008 May;46(3):545-97.[Abstract]
34. Enjolras O. Vascular malformations. In: Callen JP, Horn TD, Mancini AJ, et al, eds. Dermatology. Vol. 2. 2nd ed. St. Louis, MO: Elsevier; 2008:1581-95.
35. Pandey A, Gangopadhyay AN, Sharma SP, et al. Conservative management of ulcerated haemangioma - twenty years experience. Int Wound J. 2009 Feb;6(1):59-62.[Abstract]
36. Berenguer B, Mulliken JB, Enjolras O, et al. Rapidly involuting congenital hemangioma: clinical and histopathologic features. Pediatr Dev Pathol. 2003 Nov-Dec;6(6):495-510.[Abstract]
37. Requena C, Miranda L, Canete A, et al. Congenital fibrosarcoma simulating congenital hemangioma. Pediatr Dermatol. 2008 Jan-Feb;25(1):141-4.[Abstract]
38. Yan AC, Chamlin SL, Liang MG, et al. Congenital infantile fibrosarcoma: a masquerader of ulcerated hemangioma. Pediatr Dermatol. 2006 Jul-Aug;23(4):330-4.[Abstract]
39. North PE, Kincannon J. Vascular neoplasms and neoplastic-like proliferations. In: Callen JP, Horn TD, Mancini AJ, et al, eds. Dermatology. Vol. 2. 2nd ed. St. Louis, MO: Elsevier; 2008:1771-94.
40. Krowchuk DP, Frieden IJ, Mancini AJ, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019 Jan;143(1): e20183475.[Abstract][Full Text]
41. Zwicker K, Powell J, Cummings C. Vascular anomalies in childhood: When to treat and when to refer. Paediatr Child Health. 2022 Sep;27(5):310-4.[Abstract]
42. Izadpanah A, Izadpanah A, Kanevsky J, et al. Propranolol versus corticosteroids in the treatment of infantile hemangioma: a systematic review and meta-analysis. Plast Reconstr Surg. 2013 Mar;131(3):601-13.[Abstract]
43. Drolet BA, Frommelt PC, Chamlin SL, et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics. 2013 Jan;131(1):128-40.[Abstract]
44. Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015 Feb 19;372(8):735-46.[Abstract][Full Text]
45. Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008 Jun 12;358(24):2649-51.[Abstract]
46. Zaher H, Rasheed H, Hegazy RA, et al. Oral propranolol: an effective, safe treatment for infantile hemangiomas. Eur J Dermatol. 2011 Jul-Aug;21(4):558-63.[Abstract]
47. Fuchsmann C, Quintal MC, Giguere C, et al. Propranolol as first-line treatment of head and neck hemangiomas. Arch Otolaryngol Head Neck Surg. 2011 May;137(5):471-8.[Abstract]
48. Missoi TG, Lueder GT, Gilbertson K, et al. Oral propranolol for treatment of periocular infantile hemangiomas. Arch Ophthalmol. 2011 Jul;129(7):899-903.[Abstract]
49. Peridis S, Pilgrim G, Athanasopoulos I, et al. A meta-analysis on the effectiveness of propranolol for the treatment of infantile airway haemangiomas. Int J Pediatr Otorhinolaryngol. 2011 Apr;75(4):455-60.[Abstract]
50. Hong E, Fischer G. Propranolol for recalcitrant ulcerated hemangioma of infancy. Pediatr Dermatol. Pediatr Dermatol. 2012 Jan-Feb;29(1):64-7.[Abstract]
51. Mazereeuw-Hautier J, Hoeger PH, Benlahrech S, et al. Efficacy of propranolol in hepatic infantile hemangiomas with diffuse neonatal hemangiomatosis. J Pediatr. 2010 Aug;157(2):340-2.[Abstract]
52. Marqueling AL, Oza V, Frieden IJ, et al. Propranolol and infantile hemangiomas four years later: a systematic review. Pediatr Dermatol. 2013 Mar-Apr;30(2):182-91.[Abstract]
53. de Graaf M, Breur JM, Raphael MF, et al. Adverse effects of propranolol when used in the treatment of hemangiomas: A case series of 28 infants. J Am Acad Dermatol. 2011 Aug;65(2):320-7.[Abstract]
54. Holland KE, Frieden IJ, Frommelt PC, et al. Hypoglycemia in children taking propranolol for the treatment of infantile hemangioma. Arch Dermatol. 2010 Jul;146(7):775-8.[Abstract][Full Text]
55. Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol. 2009 Sep-Oct;26(5):610-4.[Abstract][Full Text]
56. Ni N, Langer P, Wagner R, et al. Topical timolol for periocular hemangioma: report of further study. Arch Ophthalmol. 2011 Mar;129(3):377-9.[Abstract]
57. Pope E, Chakkittakandiyil A. Topical timolol gel for infantile hemangiomas: a pilot study. Arch Dermatol. 2010 May;146(5):564-5.[Abstract][Full Text]
58. National Institute for Health and Care Excellence. Infantile haemangioma: topical timolol. Aug 2015 [internet publication].[Full Text]
59. Pope E, Krafchik BR, Macarthur C, et al. Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial. Pediatrics. 2007 Jun;119(6):e1239-47.[Abstract]
60. Rossler J, Wehl G, Niemeyer CM. Evaluating systemic prednisone therapy for proliferating haemangioma in infancy. Eur J Pediatr. 2008 Jul;167(7):813-5.[Abstract]
61. Bennett ML, Fleischer AB Jr., Chamlin SL, et al. Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation. Arch Dermatol. 2001 Sep;137(9):1208-13.[Abstract]
62. George ME, Sharma V, Jacobson J, et al. Adverse effects of systemic glucocorticosteroid therapy in infants with hemangiomas. Arch Dermatol. 2004 Aug;140(8):963-9.[Abstract][Full Text]
63. Lomenick JP, Reifschneider KL, Lucky AW, et al. Prevalence of adrenal insufficiency following systemic glucocorticoid therapy in infants with hemangiomas. Arch Dermatol. 2009 Mar;145(3):262-6.[Abstract]
64. Chantharatanapiboon W. Intralesional corticosteroid therapy in hemangiomas: clinical outcome in 160 cases. J Med Assoc Thai. 2008 Oct;91(suppl 3):S90-6.[Abstract]
65. Chen MT, Yeong EK, Horng SY. Intralesional corticosteroid therapy in proliferating head and neck hemangiomas: a review of 155 cases. J Pediatr Surg. 2000 Mar;35(3):420-3.[Abstract]
66. Buckmiller LM, Francis CL, Glade RS. Intralesional steroid injection for proliferative parotid hemangiomas. Int J Pediatr Otorhinolaryngol. 2008 Jan;72(1):81-7.[Abstract]
67. Jalil S, Akhtar J, Ahmed S. Corticosteroids therapy in the management of infantile cutaneous hemangioma. J Coll Physicians Surg Pak. 2006 Oct;16(10):662-5.[Abstract]
68. Sinno H, Thibaudeau S, Coughlin R, et al. Management of infantile parotid gland hemangiomas: a 40-year experience. Plast Reconstr Surg. 2010 Jan;125(1):265-73.[Abstract]
69. Batta K, Goodyear HM, Moss C, et al. Randomised controlled study of early pulsed dye laser treatment of uncomplicated childhood haemangiomas: results of a 1-year analysis. Lancet. 2002 Aug 17;360(9332):521-7.[Abstract]
70. Stier MF, Click SA, Hirsch RJ. Laser treatment of pediatric vascular lesions: port-wine stains and hemangiomas. J Am Acad Dermatol. 2008 Feb;58(2):261-85.[Abstract]
71. Smit JM, Bauland CG, Wijnberg DS, et al. Pulsed dye laser treatment, a review of indications and outcome based on published trials. Br J Plast Surg. 2005 Oct;58(7):981-7.[Abstract]
72. Brightman LA, Brauer JA, Terushkin V, et al. Ablative fractional resurfacing for involuted hemangioma residuum. Arch Dermatol. 2012 Nov;148(11):1294-8.[Abstract][Full Text]
73. Brandling-Bennett HA, Metry DW, Baselga E, et al. Infantile hemangiomas with unusually prolonged growth phase: a case series. Arch Dermatol. 2008 Dec;144(12):1632-7.[Abstract]
74. Li G, Xu D, Hu Z, et al. Embolic retinal and choroidal vascular occlusion after peribulbar triamcinolone injection: a case report. Medicine (Baltimore). 2018 Apr;97(17):e0467.[Abstract][Full Text]
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