Unveiling Infantile Hemangiomas: A Comprehensive Study of Patterns, Presentations, and Complications

Prashansa  Jaiswal; Jyoti Singh; Aishwarya Dua; Aaditya Sirohi; Febin Ashraf

doi:10.5826/dpc.1504a5515

Unveiling Infantile Hemangiomas: A Comprehensive Study of Patterns, Presentations, and Complications

Authors

Prashansa Jaiswal Department of Dermatology, All India Institute of Medical Sciences, Bhopal, India
Jyoti Singh Department of Dermatology, All India Institute of Medical Sciences, Bhopal, India https://orcid.org/0009-0000-9327-6476
Aishwarya Dua Skin lab by Dr Jamuna Pai, Greater Kailash-2, New Delhi, India
Aaditya Sirohi Department of CTVS, All India Institute of Medical Sciences, Bhopal, India
Febin Ashraf Department of Dermatology, All India Institute of Medical Sciences, Bhopal, India

Keywords:

Infantile hemangiomas, Clinical patterns, Presentations, Pediatric complications, Morphology

Abstract

Background: Infantile Hemangioma is the most common vascular tumor in infants, affecting 4% to 10% of this population. It typically appears as a solitary cutaneous hemangioma but can also be multifocal or segmental. The condition progresses through rapid growth, a plateau phase, and gradual involution. Key risk factors include low birth weight, prematurity, female sex, multiple gestations, and family history. Clinical presentation varies among individuals.

Objective: This study aims to analyze the clinical characteristics of patients with infantile hemangiomas at our hospital, focusing on age of onset, presentation, location, size, type, and complications.

Methods: A retrospective analysis of medical records of infants diagnosed with infantile hemangioma was conducted. Data was collected on demographics, lesion characteristics, and complications for statistical analysis.

Results: The study reviewed 694 hemangiomas in 500 patients, with 50% having a precursor lesion at birth. A significant female predominance (72%) was noted, with most patients (72%) delivered at term. The strawberry mass was the most common morphology (74%), primarily located in the head and neck (42%). Of the hemangiomas, 45% were superficial, and 88% showed progressive growth. Ten patients with periocular hemangiomas experienced amblyopia, while other complications included PHACES syndrome, ipsilateral breast hypertrophy, and arteriovenous malformations.

Conclusions: This study highlights the diverse manifestations, anomalies, and risk factors associated with infantile hemangioma in a tertiary care setting.

References

Dickison P, Christou E, Wargon O. A prospective study of infantile hemangiomas with a focus on incidence and risk factors. Pediatr Dermatol. 2011;28:663–669. DOI:10.1111/j.1525-1470.2011.01568.x | PMID:21995808.

Macca L, Altavilla D, Di Bartolomeo L, et al. Update on treatment of infantile hemangiomas: what’s new in the last five years? Front Pharmacol. 2022;13:879602. DOI:10.3389/fphar.2022.879602 | PMID:35721150.

Munden A, Butschek R, Tom WL, et al. Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies. Br J Dermatol. 2014;170:907–913. DOI:10.1111/bjd.12804 | PMID:24641194.

Ding Y, Zhang JZ, Yu SR, Xiang F, Kang XJ. Risk factors for infantile hemangioma: a meta-analysis. World J Pediatr. 2020;16:377–384. DOI:10.1007/s12519-019-00327-2 | PMID:31853885.

Chiller KG, Passaro D, Frieden IJ. Hemangiomas of infancy: clinical characteristics, morphologic subtypes, and their relationship to race, ethnicity, and sex. Arch Dermatol. 2002;138:1567–1576. DOI:10.1001/archderm.138.12.1567 | PMID:12472344.

Chen TS, Eichenfield LF, Friedlander SF. Infantile hemangiomas: an update on pathogenesis and therapy. Pediatrics. 2013;131:99–108. DOI:10.1542/peds.2012-1128 | PMID:23266916.

Greco MF, Frieden IJ, Drolet BA, et al. Infantile hemangiomas in twins: a prospective cohort study. Pediatr Dermatol. 2016;33:178–183. DOI:10.1111/pde.12781 | PMID:26863906.

Mariani LG, Ferreira LM, Rovaris DL, et al. Infantile hemangiomas: risk factors for complications, recurrence and unaesthetic sequelae. An Bras Dermatol. 2022;97:37–44. DOI:10.1016/j.abd.2021.05.009 | PMID:34848114.

Siegel DH. PHACE syndrome: infantile hemangiomas associated with multiple congenital anomalies: clues to the cause. Am J Med Genet C Semin Med Genet. 2018;178:407–413. DOI:10.1002/ajmg.c.31676 | PMID:30267463.

Girard C, Bigorre M, Guillot B, Bessis D. PELVIS syndrome. Arch Dermatol. 2006;142:884–888. DOI:10.1001/archderm.142.7.884 | PMID:16847205.

Kardasevic M, Dinarevic SM. Infantile sacral region hemangioma and combination treatment with propranolol and topical timolol: case review and reference review. Med Arch. 2021;75:158–161. DOI:10.5455/medarh.2021.75.158-161 | PMID:34219878.

Metry DW, Haggstrom AN, Drolet BA, et al. Consensus statement on diagnostic criteria for PHACE syndrome. Pediatrics. 2009;124:1447–1456. DOI:10.1542/peds.2009-0082 | PMID:19858157.

Sandru F, Turenschi A, Constantin AT, et al. Infantile hemangioma: a cross-sectional observational study. Life (Basel). 2023;13:1868. DOI:10.3390/life13091868 | PMID:37763272.

Chang LC, Haggstrom AN, Drolet BA, et al. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics. 2008;122:360–367. DOI:10.1542/peds.2007-2767 | PMID:18676554.

Suzen Orhan E, Unal EC, Tacyildiz N, Dincaslan H. Evaluation of age, gender, prenatal characteristics, and treatment results of 380 babies with infantile hemangioma. J Clin Oncol. 2021;39(15_suppl):e22018. DOI:10.1200/JCO.2021.39.15_suppl.e22018.

Chehad AS, Hamza O, Mansoul T. Clinical and epidemiological risk factors for infantile hemangioma: a case-control study. Pediatr Dermatol. 2023;40:647–650. DOI:10.1111/pde.15363 | PMID:37314056.

Lydiawati E, Zulkarnain I. Infantile hemangioma: a retrospective study. Berkala Ilmu Kesehatan Kulit dan Kelamin (Universitas Airlangga). 2020;32(1):21–26. DOI:10.20473/bikk.V32.1.2020.21-26.

Sun Y, Zhao J, Meng Y, et al. The prevalence, complications, and risk factors for infantile hemangioma: a systematic review and meta-analysis. Int J Dermatol. 2024;63:737–746. DOI:10.1111/ijd.17062 | PMID:38329175.

Hung YT, Chung WH, Chen CB. A premonitory mark of segmental infantile hemangioma. CMAJ. 2022;194:E910. DOI:10.1503/cmaj.220336 | PMID:35817428.

Strub G, Sidbury R, Bauman N. Vascular tumors: infantile hemangioma. In: Perkins J, Balakrishnan K, eds. Evidence-Based Management of Head and Neck Vascular Anomalies. Cham: Springer; 2018:37–45. Book DOI:10.1007/978-3-319-92306-2.

Leung AKC, Lam JM, Leong KF, Hon KL. Infantile hemangioma: an updated review. Curr Pediatr Rev. 2021;17:55–69. DOI:10.2174/1573396316666200508100038 | PMID:32384034.

Frieden IJ, Rogers M, Garzon MC. Conditions masquerading as infantile haemangioma: Part 1. Australas J Dermatol. 2009;50:77–97; quiz 98. DOI:10.1111/j.1440-0960.2009.00514_1.x | PMID:19397559.

Haggstrom AN, Lammer EJ, Schneider RA, Marcucio R, Frieden IJ. Patterns of infantile hemangiomas: new clues to hemangioma pathogenesis and embryonic facial development. Pediatrics. 2006;117:698–703. DOI:10.1542/peds.2005-1092 | PMID:16510649.