Materiały źródłowe

• #1 Hemangioma Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/hemangioma

  There is no known way to prevent hemangiomas.

• #2 Hemangiomas Treatment Columbia | Birthmarks Highland, Laurel, Howard County

  https://www.whitepebbledermatology.com/hemangiomas-dermatologist-columbia-md/

  Preventing hemangiomas is not possible, as they are typically present at birth. […] The cause of the hemangiomas developed at the later stages of life is not well understood. […] However, it’s important to monitor hemangiomas for any changes in size or color, and to seek medical attention if they cause discomfort or interfere with your quality of life.

• #3

  https://www.healthychildren.org/English/news/Pages/Preventing-Problems-From-Baby-Birthmark.aspx

  The American Academy of Pediatrics’ first infantile hemangioma clinical practice guideline discourages the traditional „wait and see” approach. Instead, the report calls for early identification of certain hemangiomas that may cause scarring or medical problems. […] The AAP emphasizes that early identification and monitoring is essential, however, to allow for timely treatment that can prevent medical complications or permanent disfigurement. […] But for some hemangiomas, waiting until they cause problems misses a critical window of opportunity for treatments that can prevent significant complications such as permanent scarring, skin breakdown, or medical problems, she said. […] The AAP guideline emphasizes which infantile hemangiomas are most likely to pose problems and may need treatment.

• #4

  https://www.childrensmedicalassociation.com/caring-for-your-infant-with-hemangioma

  Caring For Your Infant With Hemangioma […] Infantile hemangiomas are birth marks made up of a collection of blood vessels that formed incorrectly and proliferate rapidly. […] Careful monitoring, recognition of risk, and early intervention are key in providing the best care for your infant with hemangioma. […] As stated above, most infantile hemangiomas are benign. There are well-defined categories of infantile hemangiomas with increased risk for complication: their early recognition and treatment can prevent adverse outcomes. […] It is recommended that infants with hemangiomas that are high risk for complications be seen by a specialist by 1 month of age. […] The first-line treatment of high-risk infantile hemangiomas is oral propranolol. […] Propranolol should be administered with or after feeds, and should be held at times of diminished feeding or vomiting to reduce the risk of hypoglycemia.

• #5 Hemangioma Treatment Options – Vascular Birthmarks Foundation

  https://birthmark.org/hemangioma-information/hemangioma-treatment-options/

  One in ten children are born with a vascular birthmark, most being a hemangioma. Ninety percent (90%) will resolve on their own. The remaining 10% roughly 40,000 babies each year who will need the opinion of a specialist are the children that VBF is most concerned about because of the ongoing questions about if and when to pursue treatment. VBF pushes for early and appropriate treatment as soon as a hemangioma is diagnosed to prevent future complications both physical and psychosocial. […] A hemangioma that is ulcerating, bleeding, potentially obstructive to vision or airway, or rapidly growing, must be treated as soon as possible. […] The old school benign neglect philosophy of leave it alone, it will go away is not acceptable unless the hemangioma is insignificant and has no potential for being problematic.

• #6 Hemangioma: Types, Causes, Symptoms, Diagnosis & Treatment | Medanta

  https://www.medanta.org/hospitals-near-me/gurugram-hospital/speciality/vascular-surgery/disease/hemangiomas-types-symptoms-causes-prevention-treatment

  There are no specific preventive measures to thwart the spontaneous appearance of hemangiomas in children. These growths often emerge unpredictably during fetal development and early infancy. But there are some ways to decrease the probability of occurrence of hemangiomas in your child, such as: […] Prioritize prenatal health: While hemangiomas are not directly preventable, prioritizing a healthy pregnancy through regular prenatal check-ups and adherence to healthcare provider guidance is paramount, as it supports overall fetal well-being. […] Awareness of risk factors: Being aware of potential risk factors, such as premature birth or a family history of hemangiomas, can provide insight into the child’s predisposition to the condition. However, these factors are beyond direct control. […] Early identification and consultation: Timely detection of a hemangioma is crucial. Parents should promptly seek medical consultation if they notice unusual skin growths or changes in their child’s skin during the early weeks and months of life.

• #7 Intralesional Dexamethasone in Treatment of Hemangioma: Analysis of Outcome – MedCrave online

  https://medcraveonline.com/JPNC/intralesional-dexamethasone-in-treatment-of-hemangioma-analysis-of-outcome.html

  Hemangioma is the most common benign neoplasm of infancy. […] According to American Academy of Dermatology, the major goals of management of hemangioma includes: prevention of life threatening complication, prevention of disfigurement after involution, avoidance of potential scarring, minimizing psychological distress, and minimizing infection and pain. […] In this study, we found that number of female patient were greater and male to female ratio was 1:3.23 like many other centers. […] The authors conclude that intralesional injection of Dexamethasone is effective and safe for treatment of infantile hemangioma. To get optimum response they should be used in patients below one year of age. IH of head- neck region responded best to this therapy. Another advantage of this Intralesional Dexamethasone is that unlike systemic steroid it is free from major side effects.

• #8 Liver Hemangioma: What it Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17784-liver-hemangioma

  Are liver hemangiomas preventable? […] Since we dont know what causes them, we dont know how to prevent them. However, high estrogen may be a factor. If you have a liver hemangioma, you may be able to slow or prevent its growth by stopping or avoiding hormone replacement therapy.

• #9 Hemangioma: Types, Causes, Symptoms, Diagnosis & Treatment | Medanta

  https://www.medanta.org/hospitals-near-me/gurugram-hospital/speciality/vascular-surgery/disease/hemangiomas-types-symptoms-causes-prevention-treatment

  There are no specific preventive measures to thwart the spontaneous appearance of hemangiomas in children. These growths often emerge unpredictably during fetal development and early infancy. But there are some ways to decrease the probability of occurrence of hemangiomas in your child, such as: […] Prioritize prenatal health: While hemangiomas are not directly preventable, prioritizing a healthy pregnancy through regular prenatal check-ups and adherence to healthcare provider guidance is paramount, as it supports overall fetal well-being. […] Awareness of risk factors: Being aware of potential risk factors, such as premature birth or a family history of hemangiomas, can provide insight into the child’s predisposition to the condition. However, these factors are beyond direct control. […] Early identification and consultation: Timely detection of a hemangioma is crucial. Parents should promptly seek medical consultation if they notice unusual skin growths or changes in their child’s skin during the early weeks and months of life.

• #10 Hemangioma: Types, Causes, Symptoms, Diagnosis & Treatment | Medanta

  https://www.medanta.org/hospitals-near-me/gurugram-hospital/speciality/vascular-surgery/disease/hemangiomas-types-symptoms-causes-prevention-treatment

  There are no specific preventive measures to thwart the spontaneous appearance of hemangiomas in children. These growths often emerge unpredictably during fetal development and early infancy. But there are some ways to decrease the probability of occurrence of hemangiomas in your child, such as: […] Prioritize prenatal health: While hemangiomas are not directly preventable, prioritizing a healthy pregnancy through regular prenatal check-ups and adherence to healthcare provider guidance is paramount, as it supports overall fetal well-being. […] Awareness of risk factors: Being aware of potential risk factors, such as premature birth or a family history of hemangiomas, can provide insight into the child’s predisposition to the condition. However, these factors are beyond direct control. […] Early identification and consultation: Timely detection of a hemangioma is crucial. Parents should promptly seek medical consultation if they notice unusual skin growths or changes in their child’s skin during the early weeks and months of life.

• #11 Hemangioma: Types, Causes, Symptoms, Diagnosis & Treatment | Medanta

  https://www.medanta.org/hospitals-near-me/gurugram-hospital/speciality/vascular-surgery/disease/hemangiomas-types-symptoms-causes-prevention-treatment

  There are no specific preventive measures to thwart the spontaneous appearance of hemangiomas in children. These growths often emerge unpredictably during fetal development and early infancy. But there are some ways to decrease the probability of occurrence of hemangiomas in your child, such as: […] Prioritize prenatal health: While hemangiomas are not directly preventable, prioritizing a healthy pregnancy through regular prenatal check-ups and adherence to healthcare provider guidance is paramount, as it supports overall fetal well-being. […] Awareness of risk factors: Being aware of potential risk factors, such as premature birth or a family history of hemangiomas, can provide insight into the child’s predisposition to the condition. However, these factors are beyond direct control. […] Early identification and consultation: Timely detection of a hemangioma is crucial. Parents should promptly seek medical consultation if they notice unusual skin growths or changes in their child’s skin during the early weeks and months of life.

• #12 Hemangioma: Types, Causes, Symptoms, Diagnosis & Treatment | Medanta

  https://www.medanta.org/hospitals-near-me/gurugram-hospital/speciality/vascular-surgery/disease/hemangiomas-types-symptoms-causes-prevention-treatment

  Individualized medical guidance: Consulting with a pediatrician or dermatologist for tailored advice and management strategies is essential. Each child’s case is unique, and healthcare providers can offer personalized recommendations. […] Vigilant monitoring: Maintaining vigilance by closely monitoring the child’s skin for any developments, especially if risk factors are present, can aid in early intervention if a hemangioma does emerge. […] Genetic counseling: For parents with a family history of hemangiomas, seeking counsel from a congenital expert or healthcare provider can provide a deeper understanding of potential risks and guidance on managing concerns.

• #13 Hemangioma: Types, Causes, Symptoms, Diagnosis & Treatment | Medanta

  https://www.medanta.org/hospitals-near-me/gurugram-hospital/speciality/vascular-surgery/disease/hemangiomas-types-symptoms-causes-prevention-treatment

  Individualized medical guidance: Consulting with a pediatrician or dermatologist for tailored advice and management strategies is essential. Each child’s case is unique, and healthcare providers can offer personalized recommendations. […] Vigilant monitoring: Maintaining vigilance by closely monitoring the child’s skin for any developments, especially if risk factors are present, can aid in early intervention if a hemangioma does emerge. […] Genetic counseling: For parents with a family history of hemangiomas, seeking counsel from a congenital expert or healthcare provider can provide a deeper understanding of potential risks and guidance on managing concerns.

• #14 Hemangioma: Types, Causes, Symptoms, Diagnosis & Treatment | Medanta

  https://www.medanta.org/hospitals-near-me/gurugram-hospital/speciality/vascular-surgery/disease/hemangiomas-types-symptoms-causes-prevention-treatment

  Individualized medical guidance: Consulting with a pediatrician or dermatologist for tailored advice and management strategies is essential. Each child’s case is unique, and healthcare providers can offer personalized recommendations. […] Vigilant monitoring: Maintaining vigilance by closely monitoring the child’s skin for any developments, especially if risk factors are present, can aid in early intervention if a hemangioma does emerge. […] Genetic counseling: For parents with a family history of hemangiomas, seeking counsel from a congenital expert or healthcare provider can provide a deeper understanding of potential risks and guidance on managing concerns.

• #15 Intralesional Dexamethasone in Treatment of Hemangioma: Analysis of Outcome – MedCrave online

  https://medcraveonline.com/JPNC/intralesional-dexamethasone-in-treatment-of-hemangioma-analysis-of-outcome.html

  Hemangioma is the most common benign neoplasm of infancy. […] According to American Academy of Dermatology, the major goals of management of hemangioma includes: prevention of life threatening complication, prevention of disfigurement after involution, avoidance of potential scarring, minimizing psychological distress, and minimizing infection and pain. […] In this study, we found that number of female patient were greater and male to female ratio was 1:3.23 like many other centers. […] The authors conclude that intralesional injection of Dexamethasone is effective and safe for treatment of infantile hemangioma. To get optimum response they should be used in patients below one year of age. IH of head- neck region responded best to this therapy. Another advantage of this Intralesional Dexamethasone is that unlike systemic steroid it is free from major side effects.

• #16 Infantile Hemangioma: AAP Releases Guideline for Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p186.html

  Infantile hemangiomas that are classified as high-risk should be referred to a hemangioma subspecialist as soon as possible (strong recommendation, expert opinion). […] Parents or caregivers should be educated about the natural history of hemangiomas and the potential for causing complications or disfigurement (strong recommendation, expert opinion). […] Imaging of lesions is not necessary unless the diagnosis is uncertain, there are five or more cutaneous lesions, or anatomic abnormalities are suspected (moderate recommendation, clinical trials with minor limitations). […] Oral propranolol at 2 to 3 mg per kg daily is effective for the systemic treatment of infantile hemangiomas in the absence of structural abnormalities (strong recommendation, well-designed clinical trials and systematic review).

• #17

  https://www.childrensmedicalassociation.com/caring-for-your-infant-with-hemangioma

  Caring For Your Infant With Hemangioma […] Infantile hemangiomas are birth marks made up of a collection of blood vessels that formed incorrectly and proliferate rapidly. […] Careful monitoring, recognition of risk, and early intervention are key in providing the best care for your infant with hemangioma. […] As stated above, most infantile hemangiomas are benign. There are well-defined categories of infantile hemangiomas with increased risk for complication: their early recognition and treatment can prevent adverse outcomes. […] It is recommended that infants with hemangiomas that are high risk for complications be seen by a specialist by 1 month of age. […] The first-line treatment of high-risk infantile hemangiomas is oral propranolol. […] Propranolol should be administered with or after feeds, and should be held at times of diminished feeding or vomiting to reduce the risk of hypoglycemia.

• #18 Hemangioma Treatment Options – Vascular Birthmarks Foundation

  https://birthmark.org/hemangioma-information/hemangioma-treatment-options/

  One in ten children are born with a vascular birthmark, most being a hemangioma. Ninety percent (90%) will resolve on their own. The remaining 10% roughly 40,000 babies each year who will need the opinion of a specialist are the children that VBF is most concerned about because of the ongoing questions about if and when to pursue treatment. VBF pushes for early and appropriate treatment as soon as a hemangioma is diagnosed to prevent future complications both physical and psychosocial. […] A hemangioma that is ulcerating, bleeding, potentially obstructive to vision or airway, or rapidly growing, must be treated as soon as possible. […] The old school benign neglect philosophy of leave it alone, it will go away is not acceptable unless the hemangioma is insignificant and has no potential for being problematic.

• #19 Haemangioma – infantile

  https://www.rch.org.au/kidsconnect/prereferral_guidelines/Haemangioma_%E2%80%93_infantile/

  Most infantile haemangiomas do not require treatment. However some infants require investigations and/or treatment. Consider urgent referral to a specialist with expertise in this field if there are any of the following red flags: […] Most children do not require treatment for their haemangioma. […] For haemangiomas requiring treatment (e.g. red flags above), treatment should be started early to reduce the possibility and severity of complications. Consider urgent referral. […] If oral beta blocker (atenolol or propranolol) is commenced locally by a doctor with experience in this area, detailed guidelines have been published.

• #20 What you should know about hemangiomas

  https://answers.childrenshospital.org/what-you-should-know-about-hemangiomas/

  Hemangiomas can have many causes but aren’t hereditary. […] The location of the hemangioma can indicate how immediate treatment may be. “For example, if the hemangioma is affecting the eyelid, it could interfere with vision,” shares Dr. Liang. “That is something that we would want to treat very quickly.” […] We typically will prescribe this before your child is 4 months old, so we can shrink the hemangioma earlier in life. […] We really encourage parents to bring their child in as early as possible, because once the hemangioma is fully formed, it becomes harder to shrink using medications. […] The bottom line is that hemangiomas are easily treated and the earlier they are treated, the faster they will shrink. “Since they’re so common, we have a lot of research and variations in treatment plans for each child, so the sooner you see a doctor, the better.”

• #21 Infantile Hemangioma: AAP Releases Guideline for Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p186.html

  Infantile hemangiomas that are classified as high-risk should be referred to a hemangioma subspecialist as soon as possible (strong recommendation, expert opinion). […] Parents or caregivers should be educated about the natural history of hemangiomas and the potential for causing complications or disfigurement (strong recommendation, expert opinion). […] Imaging of lesions is not necessary unless the diagnosis is uncertain, there are five or more cutaneous lesions, or anatomic abnormalities are suspected (moderate recommendation, clinical trials with minor limitations). […] Oral propranolol at 2 to 3 mg per kg daily is effective for the systemic treatment of infantile hemangiomas in the absence of structural abnormalities (strong recommendation, well-designed clinical trials and systematic review).

• #22 Managing Circumscribed Choroidal Hemangioma – Retina Today

  https://retinatoday.com/articles/2017-nov-dec/managing-circumscribed-choroidal-hemangioma

  Circumscribed choroidal hemangioma is a benign tumor that can cause photopsia, floaters, vision loss, and, in some cases, no perceptible symptom. The median age at onset of circumscribed choroidal hemangioma is between 45 and 50 years. Over time, this vascular lesion can increase in size, leading to damage to the overlying retinal pigment epithelium and retina with resulting VA loss. Common goals for management of circumscribed choroidal hemangioma include preservation of VA and prevention of visual field loss, as well as prevention of total retinal detachment with secondary neovascular glaucoma. […] PDT is the treatment of choice for circumscribed choroidal hemangioma, especially those with serous retinal detachment. PDT is primarily used to induce tumor fibrosis, with subsequent resolution of SRF and CME.

• #23 When to stop propranolol for infantile hemangioma | Scientific Reports

  https://www.nature.com/articles/srep43292

  Propranolol is safe and effective for the treatment of IHs that require intervention, but it should be stopped at an appropriate time, which is determined primarily by the lesion regression rate after propranolol treatment. […] The ideal time to terminate propranolol is when complete regression is achieved. However, more patients experience partial regression, and their treatment course should be longer; furthermore, the recurrence rate is frequently higher among these patients. […] The use of color Doppler ultrasound creates an opportunity to critically and accurately monitor the course of IHs to help determine when to stop treatment. […] In our experience, direct termination of propranolol usually leads to rapid regrowth of primary lesions, especially for patients with partial regression. Therefore, we recommend that patients with complete regression gradually stop treatment over a period of 2 weeks and that patients with partial regression carefully terminate treatment over 4 weeks. […] Propranolol is safer than other treatments, and its side effects are usually minor. […] We suggest that propranolol be stopped at an appropriate time to avoid potential side effects under the precondition of retaining its efficacy. Overuse of propranolol should be avoided.

• #24 Infantile Hemangioma: AAP Releases Guideline for Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p186.html

  Infantile hemangiomas that are classified as high-risk should be referred to a hemangioma subspecialist as soon as possible (strong recommendation, expert opinion). […] Parents or caregivers should be educated about the natural history of hemangiomas and the potential for causing complications or disfigurement (strong recommendation, expert opinion). […] Imaging of lesions is not necessary unless the diagnosis is uncertain, there are five or more cutaneous lesions, or anatomic abnormalities are suspected (moderate recommendation, clinical trials with minor limitations). […] Oral propranolol at 2 to 3 mg per kg daily is effective for the systemic treatment of infantile hemangiomas in the absence of structural abnormalities (strong recommendation, well-designed clinical trials and systematic review).

• #25

  https://ejpd.com/index.php/journal/article/view/975

  Propranolol is the drug of first choice in the treatment of problematic hemangioma. […] Risk factors for a significant rebound in the hemangioma after discontinuation of propranolol were female sex, duration of treatment with propranolol less than 10 months, localization to the cheek and less than 30% improvement after the first month of treatment. To prevent the rebound we propose to increase the initial 2 mg/kg per day dosage of the drug up to 3 mg in cases with less than 30% improvement after the first month of therapy and increase the duration of treatment with propranolol especially in females and in hemangioma of the cheek.

• #26 Infantile Hemangioma: AAP Releases Guideline for Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p186.html

  Parents and caregivers should be told to administer propranolol with or after feeding and be educated about the adverse effects (e.g., sleep disturbance, bronchial irritation) of the medication. […] The following secondary therapies are moderate recommendations based on clinical trials with minor limitations. Oral corticosteroids can be used as secondary therapy for contraindications or lack of response to propranolol.

• #27

  https://www.childrensmedicalassociation.com/caring-for-your-infant-with-hemangioma

  Caring For Your Infant With Hemangioma […] Infantile hemangiomas are birth marks made up of a collection of blood vessels that formed incorrectly and proliferate rapidly. […] Careful monitoring, recognition of risk, and early intervention are key in providing the best care for your infant with hemangioma. […] As stated above, most infantile hemangiomas are benign. There are well-defined categories of infantile hemangiomas with increased risk for complication: their early recognition and treatment can prevent adverse outcomes. […] It is recommended that infants with hemangiomas that are high risk for complications be seen by a specialist by 1 month of age. […] The first-line treatment of high-risk infantile hemangiomas is oral propranolol. […] Propranolol should be administered with or after feeds, and should be held at times of diminished feeding or vomiting to reduce the risk of hypoglycemia.

• #28 Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-propranolol-in-treatment-infantile-hemangioma-articulo-S1578219012000315

  The therapeutic arsenal for hemangiomas in early childhood can now be considered to include oral -blockers, mainly propranolol. These drugs are thought to act as vasoconstrictors, regulating angiogenic pathways and inducing apoptosis of vascular endothelial cells. Although infantile hemangioma is not among the approved indications for -blockers, many specialized clinics will prescribe propranolol before resorting to corticosteroids. A dosage of 2mg/kg/d, is usually employed with a dosing interval of 8hours. Propranolol is safe, causing few side effects, although cases of hypoglycemia, hypotension, diarrhea, reflux, cold hands and feet, bronchospasm, and hyperkalemia have been described. Generally, these adverse effects have not had serious consequences. Prescription in PHACE syndrome is controversial. In all cases, a cardiologist should assess the patient before treatment begins, blood pressure should be monitored, and pediatric follow-up should be scheduled. This review covers our current understanding of the indications, clinical response, and adverse effects of propranolol, a drug has revolutionized our attitude toward infantile hemangioma and the way we approach therapy. Clinical trials under way are also reviewed.

• #29 The role of propranolol in the treatment of infantile hemangioma | Revista Portuguesa de Cardiologia (English edition)

  https://www.revportcardiol.org/en-the-role-propranolol-in-treatment-articulo-S217420491400124X

  In our experience propranolol appears to be a useful and safe treatment option for severe or complicated IH, achieving a rapid and significant reduction in their size. […] Propranolol is also contraindicated in patients with asthma, and it is not recommended during episodes of bronchiolitis. […] Propranolol appears to be a uniquely effective and safe therapy for infantile hemangiomas, including in the post-proliferative phase, and should be considered the first-line therapy in this setting.

• #30 What are the treatment options for hemangiomas in children (infantile hemangiomas)?

  https://www.informedhealth.org/what-are-the-treatment-options-for-hemangiomas-in-children-infantile-hemangiomas.html

  Infantile hemangiomas only have to be treated if they might cause complications because they’re especially large or in a difficult place. Then doctors usually recommend treatment with medications known as beta blockers. This stops the growth of the hemangioma. […] Getting treatment soon enough can prevent other health problems and complications caused by the hemangioma. It is best if the treatment is started when the baby is 1 to 5 months old because then the growth of the hemangioma can be stopped. […] Propranolol is usually not an option for premature babies under the age of five weeks (counting from the due date, not the actual date of birth). […] Propranolol is approved for use starting between the ages of 5 weeks and 5 months. If treatment is to be started in children who are younger or older than that, the doctor first has to give parents detailed information about the possible risks and effects associated with this treatment (off-label use). […] Other treatments are only used very rarely. There are no good studies on their pros and cons.

• #31 When to stop propranolol for infantile hemangioma | Scientific Reports

  https://www.nature.com/articles/srep43292

  Propranolol is safe and effective for the treatment of IHs that require intervention, but it should be stopped at an appropriate time, which is determined primarily by the lesion regression rate after propranolol treatment. […] The ideal time to terminate propranolol is when complete regression is achieved. However, more patients experience partial regression, and their treatment course should be longer; furthermore, the recurrence rate is frequently higher among these patients. […] The use of color Doppler ultrasound creates an opportunity to critically and accurately monitor the course of IHs to help determine when to stop treatment. […] In our experience, direct termination of propranolol usually leads to rapid regrowth of primary lesions, especially for patients with partial regression. Therefore, we recommend that patients with complete regression gradually stop treatment over a period of 2 weeks and that patients with partial regression carefully terminate treatment over 4 weeks. […] Propranolol is safer than other treatments, and its side effects are usually minor. […] We suggest that propranolol be stopped at an appropriate time to avoid potential side effects under the precondition of retaining its efficacy. Overuse of propranolol should be avoided.

• #32 When to stop propranolol for infantile hemangioma | Scientific Reports

  https://www.nature.com/articles/srep43292

  Propranolol is safe and effective for the treatment of IHs that require intervention, but it should be stopped at an appropriate time, which is determined primarily by the lesion regression rate after propranolol treatment. […] The ideal time to terminate propranolol is when complete regression is achieved. However, more patients experience partial regression, and their treatment course should be longer; furthermore, the recurrence rate is frequently higher among these patients. […] The use of color Doppler ultrasound creates an opportunity to critically and accurately monitor the course of IHs to help determine when to stop treatment. […] In our experience, direct termination of propranolol usually leads to rapid regrowth of primary lesions, especially for patients with partial regression. Therefore, we recommend that patients with complete regression gradually stop treatment over a period of 2 weeks and that patients with partial regression carefully terminate treatment over 4 weeks. […] Propranolol is safer than other treatments, and its side effects are usually minor. […] We suggest that propranolol be stopped at an appropriate time to avoid potential side effects under the precondition of retaining its efficacy. Overuse of propranolol should be avoided.

• #33 When to stop propranolol for infantile hemangioma | Scientific Reports

  https://www.nature.com/articles/srep43292

  Propranolol is safe and effective for the treatment of IHs that require intervention, but it should be stopped at an appropriate time, which is determined primarily by the lesion regression rate after propranolol treatment. […] The ideal time to terminate propranolol is when complete regression is achieved. However, more patients experience partial regression, and their treatment course should be longer; furthermore, the recurrence rate is frequently higher among these patients. […] The use of color Doppler ultrasound creates an opportunity to critically and accurately monitor the course of IHs to help determine when to stop treatment. […] In our experience, direct termination of propranolol usually leads to rapid regrowth of primary lesions, especially for patients with partial regression. Therefore, we recommend that patients with complete regression gradually stop treatment over a period of 2 weeks and that patients with partial regression carefully terminate treatment over 4 weeks. […] Propranolol is safer than other treatments, and its side effects are usually minor. […] We suggest that propranolol be stopped at an appropriate time to avoid potential side effects under the precondition of retaining its efficacy. Overuse of propranolol should be avoided.

• #34

  https://ejpd.com/index.php/journal/article/view/975

  Propranolol is the drug of first choice in the treatment of problematic hemangioma. […] Risk factors for a significant rebound in the hemangioma after discontinuation of propranolol were female sex, duration of treatment with propranolol less than 10 months, localization to the cheek and less than 30% improvement after the first month of treatment. To prevent the rebound we propose to increase the initial 2 mg/kg per day dosage of the drug up to 3 mg in cases with less than 30% improvement after the first month of therapy and increase the duration of treatment with propranolol especially in females and in hemangioma of the cheek.

• #35 Infantile Hemangioma: AAP Releases Guideline for Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p186.html

  Parents and caregivers should be told to administer propranolol with or after feeding and be educated about the adverse effects (e.g., sleep disturbance, bronchial irritation) of the medication. […] The following secondary therapies are moderate recommendations based on clinical trials with minor limitations. Oral corticosteroids can be used as secondary therapy for contraindications or lack of response to propranolol.

• #36 Intralesional Dexamethasone in Treatment of Hemangioma: Analysis of Outcome – MedCrave online

  https://medcraveonline.com/JPNC/intralesional-dexamethasone-in-treatment-of-hemangioma-analysis-of-outcome.html

  Hemangioma is the most common benign neoplasm of infancy. […] According to American Academy of Dermatology, the major goals of management of hemangioma includes: prevention of life threatening complication, prevention of disfigurement after involution, avoidance of potential scarring, minimizing psychological distress, and minimizing infection and pain. […] In this study, we found that number of female patient were greater and male to female ratio was 1:3.23 like many other centers. […] The authors conclude that intralesional injection of Dexamethasone is effective and safe for treatment of infantile hemangioma. To get optimum response they should be used in patients below one year of age. IH of head- neck region responded best to this therapy. Another advantage of this Intralesional Dexamethasone is that unlike systemic steroid it is free from major side effects.

• #37

  https://www.childrensmedicalassociation.com/caring-for-your-infant-with-hemangioma

  For patients in whom propranolol is contraindicated, poorly tolerated or ineffective, second-line treatment of high-risk infantile hemangiomas is steroids, either orally or by direct injection into the high-risk lesion. […] Surgical interventions during infancy are generally avoided (risk of anesthesia and bleeding), though high-risk lesions that are not responsive to oral propranolol may require surgery. […] We are here for you. If you have concerns about your infants hemangioma, particularly if it is rapidly growing between the 1 month and 2 month check-up appointments, reach out on the portal or schedule an appointment to come see us in the office.

• #38

  https://www.childrensmedicalassociation.com/caring-for-your-infant-with-hemangioma

  For patients in whom propranolol is contraindicated, poorly tolerated or ineffective, second-line treatment of high-risk infantile hemangiomas is steroids, either orally or by direct injection into the high-risk lesion. […] Surgical interventions during infancy are generally avoided (risk of anesthesia and bleeding), though high-risk lesions that are not responsive to oral propranolol may require surgery. […] We are here for you. If you have concerns about your infants hemangioma, particularly if it is rapidly growing between the 1 month and 2 month check-up appointments, reach out on the portal or schedule an appointment to come see us in the office.

• #39 Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-propranolol-in-treatment-infantile-hemangioma-articulo-S1578219012000315

  Treatment should be decided on the basis of individual circumstances, such as the size and location of the tumor, complications, the phase at the time of evaluation, the involvement of other organs, and psychological factors. Here we will discuss the novel and highly promising use of -blockers to treat hemangiomas of infancy. Propranolol is proving very effective in this setting and its use is therefore growing. As a result, surgical intervention is usually needed only when involution has been incomplete and removal of residual tissue or other corrective measures are required. […] Propranolol can be restarted in these cases and the outcome is usually good, but the general recommendation is to maintain treatment until the proliferative phase has ended or until 12 months of age. […] Given the excellent responses to these drugs to date, however, the indications will certainly be increasing. Parents must be warned that -blockers are not yet approved for hemangiomas of infancy and it is helpful to mention that corticosteroids are not so-approved either and their written informed consent must be obtained. Although adverse effects have been described in isolated cases, we can say that -blockers are safe in infants with these tumors. Publications describing ever larger series are confirming the absence of adverse events, even in low-birth-weight newborns.

• #40 Managing Circumscribed Choroidal Hemangioma – Retina Today

  https://retinatoday.com/articles/2017-nov-dec/managing-circumscribed-choroidal-hemangioma

  Circumscribed choroidal hemangioma is a benign tumor that can cause photopsia, floaters, vision loss, and, in some cases, no perceptible symptom. The median age at onset of circumscribed choroidal hemangioma is between 45 and 50 years. Over time, this vascular lesion can increase in size, leading to damage to the overlying retinal pigment epithelium and retina with resulting VA loss. Common goals for management of circumscribed choroidal hemangioma include preservation of VA and prevention of visual field loss, as well as prevention of total retinal detachment with secondary neovascular glaucoma. […] PDT is the treatment of choice for circumscribed choroidal hemangioma, especially those with serous retinal detachment. PDT is primarily used to induce tumor fibrosis, with subsequent resolution of SRF and CME.

• #41 Managing Circumscribed Choroidal Hemangioma – Retina Today

  https://retinatoday.com/articles/2017-nov-dec/managing-circumscribed-choroidal-hemangioma

  When PDT is ineffective, plaque brachytherapy is typically considered. […] Plaque radiotherapy is most often used for large choroidal hemangioma, especially those with near total or total retinal detachment with SRF. Additionally, plaque radiotherapy can be used as a rescue treatment in the event of continuing tumor activity after failed PDT. […] Treatment of circumscribed choroidal hemangioma is reserved for eyes with visual compromise. PDT is the treatment of choice. However, if PDT fails to resolve SRF, then I-125 plaque radiotherapy is an option.

• #42 Infantile Hemangioma: AAP Releases Guideline for Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p186.html

  Infantile hemangiomas that are classified as high-risk should be referred to a hemangioma subspecialist as soon as possible (strong recommendation, expert opinion). […] Parents or caregivers should be educated about the natural history of hemangiomas and the potential for causing complications or disfigurement (strong recommendation, expert opinion). […] Imaging of lesions is not necessary unless the diagnosis is uncertain, there are five or more cutaneous lesions, or anatomic abnormalities are suspected (moderate recommendation, clinical trials with minor limitations). […] Oral propranolol at 2 to 3 mg per kg daily is effective for the systemic treatment of infantile hemangiomas in the absence of structural abnormalities (strong recommendation, well-designed clinical trials and systematic review).

• #43 Hemangioma Treatment Options – Vascular Birthmarks Foundation

  https://birthmark.org/hemangioma-information/hemangioma-treatment-options/

  One in ten children are born with a vascular birthmark, most being a hemangioma. Ninety percent (90%) will resolve on their own. The remaining 10% roughly 40,000 babies each year who will need the opinion of a specialist are the children that VBF is most concerned about because of the ongoing questions about if and when to pursue treatment. VBF pushes for early and appropriate treatment as soon as a hemangioma is diagnosed to prevent future complications both physical and psychosocial. […] A hemangioma that is ulcerating, bleeding, potentially obstructive to vision or airway, or rapidly growing, must be treated as soon as possible. […] The old school benign neglect philosophy of leave it alone, it will go away is not acceptable unless the hemangioma is insignificant and has no potential for being problematic.

• #44 What you should know about hemangiomas

  https://answers.childrenshospital.org/what-you-should-know-about-hemangiomas/

  Hemangiomas can have many causes but aren’t hereditary. […] The location of the hemangioma can indicate how immediate treatment may be. “For example, if the hemangioma is affecting the eyelid, it could interfere with vision,” shares Dr. Liang. “That is something that we would want to treat very quickly.” […] We typically will prescribe this before your child is 4 months old, so we can shrink the hemangioma earlier in life. […] We really encourage parents to bring their child in as early as possible, because once the hemangioma is fully formed, it becomes harder to shrink using medications. […] The bottom line is that hemangiomas are easily treated and the earlier they are treated, the faster they will shrink. “Since they’re so common, we have a lot of research and variations in treatment plans for each child, so the sooner you see a doctor, the better.”

• #45 Haemangioma – infantile

  https://www.rch.org.au/kidsconnect/prereferral_guidelines/Haemangioma_%E2%80%93_infantile/

  Most infantile haemangiomas do not require treatment. However some infants require investigations and/or treatment. Consider urgent referral to a specialist with expertise in this field if there are any of the following red flags: […] Most children do not require treatment for their haemangioma. […] For haemangiomas requiring treatment (e.g. red flags above), treatment should be started early to reduce the possibility and severity of complications. Consider urgent referral. […] If oral beta blocker (atenolol or propranolol) is commenced locally by a doctor with experience in this area, detailed guidelines have been published.

• #46 What you should know about hemangiomas

  https://answers.childrenshospital.org/what-you-should-know-about-hemangiomas/

  Hemangiomas can have many causes but aren’t hereditary. […] The location of the hemangioma can indicate how immediate treatment may be. “For example, if the hemangioma is affecting the eyelid, it could interfere with vision,” shares Dr. Liang. “That is something that we would want to treat very quickly.” […] We typically will prescribe this before your child is 4 months old, so we can shrink the hemangioma earlier in life. […] We really encourage parents to bring their child in as early as possible, because once the hemangioma is fully formed, it becomes harder to shrink using medications. […] The bottom line is that hemangiomas are easily treated and the earlier they are treated, the faster they will shrink. “Since they’re so common, we have a lot of research and variations in treatment plans for each child, so the sooner you see a doctor, the better.”

• #47 Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations | Actas Dermo-Sifiliográficas

  https://www.actasdermo.org/es-propranolol-in-treatment-infantile-hemangioma-articulo-S1578219012000315

  Treatment should be decided on the basis of individual circumstances, such as the size and location of the tumor, complications, the phase at the time of evaluation, the involvement of other organs, and psychological factors. Here we will discuss the novel and highly promising use of -blockers to treat hemangiomas of infancy. Propranolol is proving very effective in this setting and its use is therefore growing. As a result, surgical intervention is usually needed only when involution has been incomplete and removal of residual tissue or other corrective measures are required. […] Propranolol can be restarted in these cases and the outcome is usually good, but the general recommendation is to maintain treatment until the proliferative phase has ended or until 12 months of age. […] Given the excellent responses to these drugs to date, however, the indications will certainly be increasing. Parents must be warned that -blockers are not yet approved for hemangiomas of infancy and it is helpful to mention that corticosteroids are not so-approved either and their written informed consent must be obtained. Although adverse effects have been described in isolated cases, we can say that -blockers are safe in infants with these tumors. Publications describing ever larger series are confirming the absence of adverse events, even in low-birth-weight newborns.

• #48 What are the treatment options for hemangiomas in children (infantile hemangiomas)?

  https://www.informedhealth.org/what-are-the-treatment-options-for-hemangiomas-in-children-infantile-hemangiomas.html

  Infantile hemangiomas only have to be treated if they might cause complications because they’re especially large or in a difficult place. Then doctors usually recommend treatment with medications known as beta blockers. This stops the growth of the hemangioma. […] Getting treatment soon enough can prevent other health problems and complications caused by the hemangioma. It is best if the treatment is started when the baby is 1 to 5 months old because then the growth of the hemangioma can be stopped. […] Propranolol is usually not an option for premature babies under the age of five weeks (counting from the due date, not the actual date of birth). […] Propranolol is approved for use starting between the ages of 5 weeks and 5 months. If treatment is to be started in children who are younger or older than that, the doctor first has to give parents detailed information about the possible risks and effects associated with this treatment (off-label use). […] Other treatments are only used very rarely. There are no good studies on their pros and cons.

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