About Hemangioma of Infancy

Hemangioma of infancy,caused by a proliferation of endothelial cells (which line blood vessels), is the most common tumor of infancy. Hemangioma of infancy ranges in color from red to purple, and are soft and compressible. Lesions are usually solitary, favoring the head and neck.  Girls are affected more often than boys. Hemangioma of infancy is not present at birth but appears postnatally.

Hemangioma of infancy goes through three stages: proliferation, involution, and involuted.  The proliferation stage usually occurs during the first year of life, during which the hemangioma can enlarge rapidly.  The hemangioma then gradually involutes over the two to six years, and is usually completely involuted by the fifth year. Ulceration may occur in the course of regression. Hemangioma of infancy usually resolves without scarring, but atrophy, depigmentation and scarring sometimes occur.

Variations of hemangioma of infancy include deep hemangioma, multiple hemangiomas of infancy and congenital hemangiomas.  Deep hemangiomas are located deep in the dermis or subcutaneous fat and are typically bluish in color, possibly with overlying telangiectases or a superficial hemangioma of infancy. Multiple hemangiomas of infancy are small papular lesions that can affect either skin alone (termed benign cutaneous hemangiomatosis) or skin and internal organs (termed diffuse neonatal hemangiomatosis). Congenital hemangiomas are present at birth, unlike hemangioma of infancy. They are divided into rapidly involuting congenital hemangiomas (RICH) and non-involuting congential hemangiomas (NICH).

Hemangiomas of infancy may interfere with vital functions such as vision or breathing during the proliferation stage. Specific subtypes (tufted angiomas and Kaposiform hemangioendothelioma) may give rise to the Kasabach-Merritt syndrome, in which platelets get entrapped in the hemangioma leading to thrombocytopenia.

Infantile hemangiomas that do no interfere with vital functions are best observed for resolution. Treatment options, if necessary, include: pulse dye laser, cryosurgery, intralesional or systemic glucocorticoids, interferon alpha, and most recently propanolol. Deep hemangiomas rarely regress and may warrant surgery.

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