Haemangioma

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).

Infantile haemangiomas, referred to by many simply as 'haemangiomas', are benign vascular lesions. Typically they appear during the first weeks of life as blue or pink macules or patches. They subsequently enter a proliferative phase and may become elevated above the surrounding skin surfaces. This growth pattern distinguishes haemangiomas from other vascular lesions. The proliferative growth phase of most haemangiomas is usually completed by age 5 months; 80% of growth typically occurs by the end of the third month. Thereafter involution occurs with 90% completion by age 4 years.[1]Krowchuk DP, Frieden IJ, Mancini AJ, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019 Jan;143(1): e20183475. https://pediatrics.aappublications.org/content/143/1/e20183475.long http://www.ncbi.nlm.nih.gov/pubmed/30584062?tool=bestpractice.com Complete resolution is possible, but in many cases cutaneous stigmata remain, with redundant fibro-fatty tissue and telangiectasias.[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.[3]Chang LC, Haggstrom AN, Drolet BA, et al. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics. 2008 Aug;122(2):360-7. http://www.ncbi.nlm.nih.gov/pubmed/18676554?tool=bestpractice.com Congenital haemangiomas are distinct from infantile haemangiomas. These are vascular lesions that sometimes have a similar clinical appearance to infantile haemangiomas but are fully formed at birth. Specific subtypes of congenital haemangioma include rapidly involuting congenital haemangiomas and non-involuting congenital haemangiomas. The term 'haemangioma' is sometimes used to describe acquired lesions in adults (e.g., cherry haemangioma). These benign lesions rarely undergo involution.