Infantile Hemangiomas Research Articles

Emergency consultations to pediatric dermatology at a large children’s hospital in Saudi Arabia

Dermatology is commonly considered a non-urgent and outpatient-centered specialty. Limited studies have evaluated skin diseases presenting to the pediatric emergency department. This study aims to characterize the most common pediatric dermatological conditions prompting an emergency department visit between August 2018 and August 2023 in a large children’s hospital in Riyadh, Saudi Arabia. A total of 183 patients were included. The majority of patients were 2 years old and younger [87 (47.5%)]. Gender was almost equally distributed, with 51.4% of the population being females. Infectious and inflammatory disorders were the most commonly encountered conditions, accounting for 35.5% and 33.9%, respectively. The top three diagnoses were atopic dermatitis (12.02%), impetigo (6.56%), and infantile hemangioma (6.01%). Understanding the variety of skin disorders presented to pediatric emergency departments can positively enhance patient care in dermatology clinics and promote preventative public health initiatives, thus minimizing emergency department visits.

Intramuscular hemangioma capillary type with HRAS mutation: Expanding the molecular genetic spectrum with an emphasis on overlap with arteriovenous malformations and distinct from infantile hemangioma

AimsIntramuscular hemangioma capillary type (IHCT) is a rare entity that refers to fast-flow vascular lesions. This study aims to elucidate the relationships between clinicopathological, radiological, and molecular characteristics in IHCT patients. Methods and resultsWe reviewed all IHCT cases which were treated surgically in our pathology database from 2014 to 2023. Ten cases were analyzed via next-generation sequencing (NGS) and Sanger sequencing. The cohort consisted of 10 patients (6 males, 4 females) with a median age of 18 years (range: 1–37). Disease lesions were located in the trunk (n = 4), upper extremity (n = 2), lower extremity (n = 2), shoulder (n = 1), and neck (n = 1). IHCT is most commonly a progressively increasing painless mass. Histopathologically, all lesions exhibited aggregates, lobules, and anastomosing cords of capillary-type vessels separating or infiltrating the skeletal muscles. Four cases exhibited irregularly dilated vessels with thick walls, such as arteriovenous malformations (AVM) in the lesion's periphery. MRI findings commonly demonstrated a well-delineated, homogeneous mass. Somatic mutations were detected in seven of the ten IHCT cases. Four cases harbored mutations in MAP2K1 (p.Q58_E62del, p.K57_G61del, p.K57 N), two cases harbored mutations in KRAS (p.Q61R and p.L56V, p.G13R), and one case harbored a mutation in HRAS (p.D69_Q70insRWYSAMRD). Mutant allele frequencies detected by sequencing ranged from 9.98% to 15.97%. ConclusionsThe hemodynamic and molecular genetic phenotypes of IHCT closely resemble those observed in AVMs. Newly identified KRAS missense mutations, including cases with coexisting mutation types, and HRAS insertion mutations offer valuable insights into the genetic basis of vascular anomalies. These findings may also present potential targets for the development of novel pharmacotherapeutic interventions.

Clinical Profile and Surgical Management of Intramedullary Spinal Cord Tumors

Background and Aim: Intramedullary spinal cord tumors (IMSCTs) are rare tumors of the spine. The study aims to analyze the clinical profile and surgical management of IMSCTs. Methods and Materials/Patients: This is a retrospective study to review the IMSCTs operated between January 2007 to December 2021. Myxopapillary ependymomas were excluded from the study. Results: There were twenty-seven operated cases of IMSCTs. The Mean±SD age was 39±22 years. Fifteen (55.5%) were males and 12(44.5%) were female patients. There were 6(22%) cervical, 7(26%) cervicodorsal, 9 (33%) dorsal, and 5(19%) dorsolumbar IMSCTs. The Mean±SD duration of symptoms was 10±14 months. Ten (37%) patients had spinal cord syrinx. Motor weakness and pain were the most common symptoms. Intraoperative gross total resection (GTR) was achieved in 12(44.4%) patients, near-total resection in 4(14.8%) patients, subtotal resection in 2(7.4%) patients, decompression in 7(26%) patients, and biopsy in 2(7.4%) patients. Eighteen (66.6%) patients had neurological status same as preoperative status. Four (14.8%) patients had improvement and 5(18.5%) patients had deterioration in neurological status. Ependymoma was the most common histological type of IMSCT (40.5%). Other lesions are glioma, hemangioblastoma, lipoma, schwannoma, lymphoma, capillary hemangioma, arachnoid cyst, and epidermoid cyst with spinal dysraphism. Ependymomas had well-defined margins compared to other gliomas. Duration of stay in the hospital was 9±3.5 days. Conclusion: Dorsal spine is the most common location of IMSCTs and ependymoma is the most common histological type. It is the surgeon’s intraoperative decision regarding the extent of resection of the tumor based on the spinal cord infiltration and tumor type. GTR is possible in the majority of ependymomas and some other histological tumors like schwannoma, arachnoid cyst, and epidermoid cyst.

Botryomycoma of the Nasal Vestibule: A Case Report from the Commune VI Referral Health Center of the District of Bamako/Mali

Pyogenic granuloma or botryomycoma or lobular capillary hemangioma is a benign proliferation of capillaries, precisely skin and mucous membranes. This pathology is considered rare in terms of nasal cavities. But cases are increasingly related to literature. Thus, this study concerns a case sitting at the level of the nasal vestibule. He is an adult of 58 years and male sex, who came for consultation in the ENT department at the commune VI reference health center of the district of Bamako / Mali, presenting as a reason for consultation a right nasal obstruction. The interrogation revealed that the start dates back to about eight months and marked by a serous rhinorrhea and an associated homolateral epistaxis of headaches. No predisposing factor and no medico-surgical history has been found. The scanner allowed us to define the contours of the mass and to guide the therapeutic decision. The mass was completely removed surgically into endonasal without incidence. Histological examination of the surgical sample concluded that a lobular capillary hemangioma. The patient was followed for 2 years without recurrence or complications. Because of its rarity in our context, we recommend particular attention to ENT specialists to avoid confusion and allow more studies for more discussions in the literature.

Vascular Anomalies Review of the Head and Neck for Physicians in Training

A basic understanding of vascular anomalies will aid physicians-in-training as they seek to properly diagnose and determine interventions for these patient presentations. The aim of this review is to create a resource for physicians in training that encompasses the most important clinical aspects of vascular anomalies. Vascular anomalies of the head and neck are divided into two categories: vascular tumors and vascular malformations. This review will first describe vascular tumors followed by vascular malformations. This review discusses major pathology found in both categories of vascular anomaly. Vascular anomalies are frequently found in pediatric populations and can persist into adulthood, making it important for trainees to identify them on physical exam. This developing field seeks to improve form, function, and quality of life for patients with vascular anomalies and often requires a multidisciplinary approach (i.e., otolaryngology, dermatology, genetics, plastic surgery, interventional radiology). Various medical and surgical treatment options are available. A basic knowledge of these anomalies will allow for accurate, early diagnosis and appropriate intervention which can ultimately improve patient outcomes. Search Strategy and Selection Criteria: The MEDLINE/PubMed database was searched for primary research and reviews discussing various vascular anomalies which include infantile hemangioma, congenital hemangioma, pyogenic granuloma, tufted angioma, kaposiform hemangioendothelioma, capillary malformations, lymphatic malformations, venous malformations, and arteriovenous malformations. This search was conducted from 7/5/2023 to 3/21/2024.

An Unusual Skin Finding in a Rare Case of Goltz Syndrome

Abstract Introduction/Objective Goltz Syndrome (Focal Dermal Hypoplasia) is a rare X linked dominant genetic disorder with various dermatologic, musculoskeletal and neurologic manifestations, secondary to a mutation in the PORCN gene. Skin findings include telangiectasias, raspberry-like papillomas (angiofibroma like lesions), nodular fat herniation, xerosis and photosensitivity. Lesions are bilateral, and asymmetrically distribututed along the lines of Blasco. The adipocytic lesions can be diagnosed via a skin biopsy showing adipose tissue in the superficial epidermis and dermis or via molecular techniques showing a mutation in the PORCN gene. Here we report a case of Goltz Syndrome with unique dermal findings. Methods/Case Report A male infant presented at birth with mild diffuse xerosis, large hypopigmented and depigmented atrophic patches and plaques and multiple pink yellow red exophyitic soft papules distributed asymetrically across the body along the lines of Blascho. Additionally the patient had clinodactly, widely spaced nipples, extra pads of fat in the toes and philtrum and fingernails with longitudal ridges and lateral nail plate deviation. A diagnosis of Goltz syndrome was made via molecular analysis that showed mosiacism at C.502G>A (p.Gly168Arg) in the PORCN gene. The patient had a very superficial 2-3 mm erosion at the intersection between the scrotum and perineum. At 18 months, this had grown to finger like projections and eventually grew into multiple tan red exophytic warty papillomatous telangactatic like lesions measuring 3.0 x 0.8 cm that were painful and bled easily. A biopsy of this lesion showed focal mild epidermal hyperplasia and elongation of the rete ridges with wide spread diffuse vascular proliferation with multiple ectactic vessels along with mild dermal and perivascular inflammatory infiltrates. Also noted was infiltration of mature adipose tissue in the superficial epidermis and dermis. We preformed elastin and trichrome stains to identify if this lesion was reactive in nature or de novo. Our results showed retained elastin staining with a negative trichrome eluding to a denovo process. Additionally GLUT1 was negative, ruling out an infantile hemangioma. The above findings in this lesion do not represent any previously described dermatologic entity. Results (if a Case Study enter NA) NA Conclusion This is a rare and unique dermatologic finding of a case of Goltz sydrome, which itself is a rare disorder. In our literature review, this is the only case of Goltz Syndrome thusfar to have presented with this unique skin lesion.

Immunohistochemical and ultrastructural identification of telocytes in the infantile hemangioma

ABSTRACT Telocytes (TCs) are a distinctive cell entity of the stromal microenvironment of multiple tumors; to date, their existence in infantile hemangioma (IH) remains almost unexplored. This study was therefore undertaken to characterize the immunophenotype, location, morphology, and ultrastructure of telocytes in the IH by means of immunohistochemistry, immunofluorescence confocal microscopy, and transmission electron microscopy. Telocytes were initially identified by CD34, PDGFR-α, Vimentin, and AQP-1 immunostaining. Analyzing the spatial relationship among telocytes, stem cells, endothelial cells, pericytes in the IH with AQP-1/CD31, AQP-1/Glut-1, AQP-1/α-SMA, AQP-1/CD146 and AQP-1/CD133 double immunofluorescence. TCs were immunonegative for CD31, Glut-1, CD146, α-SMA, CD133, and C-kit in the IH. The ultrastructural examination confirmed the presence of TCs, namely stromal cells with characteristic cytoplasmic processes (i.e. telopodes) forming labyrinthine networks around microvessels and releasing extracellular vesicles. Our study provides evidence that telocytes are present and PDGFR-α and AQP-1 are specific antigenic markers in the IH.

From Presentation to Resolution: Documenting a Lobular Capillary Hemangioma of the Eyelid

From Presentation to Resolution: Documenting a Lobular Capillary Hemangioma of the Eyelid

Targeting ESM1 via SOX4 promotes the progression of infantile hemangioma through the PI3K/AKT signaling pathway

Targeting ESM1 via SOX4 promotes the progression of infantile hemangioma through the PI3K/AKT signaling pathway

Safety of Prior Propranolol Therapy for Infantile Hemangioma.

Propranolol has been the primary treatment for infantile hemangioma (IH) since 2008. Prior studies have investigated the effects in late childhood of propranolol therapy given in infancy for IH, including neurocognitive dysfunction, sleep disorders, and hypoglycemia. However, few studies have determined the risk of these adverse effects later in life. Using the TrinetX database, we studied the risk of growth impairment, sleep disorders, learning disabilities, and diabetes mellitus in children aged 10-17 years who had received propranolol for IH in infancy. The maximum age of 17 years was chosen for the study, as propranolol was established as a treatment for IH in 2008. The results showed no statistically significant risk of growth impairment, sleep disorders, learning disabilities, or diabetes mellitus in IH patients treated with propranolol. These findings support existing evidence that propranolol therapy given in infancy for IH is not associated with long-term adverse effects up to age 17 years in the studied patient population.

A COMPARATIVE STUDY OF CLINICOHISTOPATHOLOGICAL CORRELATION IN PATIENTS OF PSORIASIS AND PSORIASIFORM LESIONS WITH KI67 AND CD34 IMMUNOHISTOCHEMICAL EXPRESSION

Objectives: Psoriasis, characterized by chronic inflammation of the skin, stands as a notable example of a psoriasiform tissue pattern. In dermatology, the term “psoriasiform dermatitis” frequently appears across various inflammatory skin conditions, presenting challenges for dermatologists and pathologists alike in accurate differentiation. Relying solely on clinical features may prove insufficient in distinguishing between psoriasis and other psoriasiform dermatoses. Therefore, comprehensive differentiation requires consideration of clinical, histopathological, and immunohistochemical factors. Our study is to compare the clinicohistopathological features of psoriasis and psoriasiform dermatitis and to evaluate the immunohistochemical expression of CD34 and Ki67 in psoriasis and psoriasiform dermatitis. Methods: This retrospective study was conducted at the Department of Pathology, Mediciti Institute of Medical Sciences, Ghanpur, focusing on cases between January 1, 2020, and December 31, 2022. Clinical histories were extracted from requisition forms submitted by the Department of Dermatology. The study analyzed paraffin blocks from 50 patients each diagnosed with psoriasis and psoriasiform dermatitis. Formalin-fixed paraffin-embedded tissue samples were processed into 4-micron sections and initially stained with hematoxylin and eosin. The immunohistochemical analysis included primary antibodies against Ki-67 and CD34, with positive controls sourced from strongly positive samples of squamous cell carcinoma and capillary hemangioma, respectively. Appropriate negative controls were employed to ensure the accuracy of our findings. Results: In our study, we analyzed a total of 100 cases, comprising 50 cases each of psoriasis and psoriasiform dermatitis. Among the psoriasis cases, there was a male predominance with 29 males and 21 females, while psoriasiform dermatitis also showed male predominance with 32 males. The mean age was 33.8 years for psoriasis and 34.8 years for psoriasiform dermatitis. The majority of psoriasis cases fell in the 21–30 years age range, whereas for psoriasiform dermatitis, it was between 31 and 40 years. Significantly, our immunohistochemical analysis revealed that the mean staining intensity of the two markers was notably higher in psoriasis compared to psoriasiform dermatitis. Conclusions: In our study, we observed that the expression levels of Ki-67 and CD34 biomarkers were significantly elevated in psoriasis compared to psoriasiform dermatitis. Notably, four cases of psoriasiform dermatitis demonstrated positivity for CD34 in our analysis. This finding suggests a potential avenue for further research to explore the implications of CD34 positivity in psoriasis.

Efficacy and safety of atenolol versus propranolol for treatment of infantile haemangioma: A narrative review.

Infantile haemangiomas (IH) remain the most common benign vascular tumours in childhood. While most IH can be managed conservatively, a proportion of these lesions can cause disfigurement, ulceration or functional impairment, requiring prompt intervention. Propranolol, a lipophilic non-selective beta blocker, has been regarded as first-line therapy, following a serendipitous discovery of its use for IH in 2008. While efficacious, it has been associated with adverse effects such as hypoglycaemia, bronchospasm, sleep disturbances and agitation in infant trials. Hence, atenolol, a hydrophilic beta-1 selective blocker, has demonstrated similar efficacy and potentially greater tolerability, being less likely to cause sleep disturbances given its inability to cross the blood brain barrier, and a decrease in bronchial reactivity. The purpose of this review is to explore and critique the current knowledge on the efficacy and safety of propranolol against atenolol in children with IH. A total of seven studies comparing the two beta-blockers were identified in our search. Atenolol appeared to be as efficacious as propranolol and was associated with fewer central nervous system and bronchial-related adverse events. Further research exploring the optimal dosing for atenolol, particularly for ulcerated or syndromic IH, as well as incidence and management of rebound growth would be beneficial.

A retrospective multicenter cohort study of differences in clinical characteristics of Infantile Hemangiomas in preterm and term infants: Prematurity increases risk of permanent cutaneous sequelae

BackgroundWe observed many preterm infants with unexpectedly thick infantile hemangiomas (IH), a subtype known to be associated with increased risk of scarring. ObjectiveTo compare the clinical features of localized IH in preterm versus term infants. MethodsA retrospective study at three tertiary referral centers was conducted on 830 consecutive patients with localized IH. ResultsPreterm infants had a significantly higher incidence of superficial IH (75% in <33weeks, 57% in 33-<37 weeks, and 50% in term infants, p=0.007). Overall, their IH had thicker superficial components (p<0.001) and more stepped borders (p<0.001). These features correlated with the degree of prematurity. The average chronological age at presentation to the specialist was 5.6 (SD=6.2) months, with no difference between gestational age. LimitationsThe retrospective design and use of non-standardized clinical photographs. There may be biases introduced toward more severe IH types because the study sites were tertiary referral centers. ConclusionPreterm infants have features of IH that have obvious implication for systemic therapies. Most of these infants were seen beyond the typical proliferative phase when irreversible skin changes may have already occurred.

Intravenous pyogenic granuloma of the external jugular vein

AbstractIntravenous pyogenic granuloma (IVPG) represents a subset of lobular capillary haemangioma. The preoperative diagnosis is complex due to the absence of distinct features specific to a particular diagnosis in the clinical presentation. Physical examination findings closely mimic those of other soft tissue growths. Ultrasound should be the preferred modality for preoperative diagnostic imaging, as the lesion typically exhibits consistent ultrasound characteristics. This knowledge is imperative for an accurate and timely diagnosis. This case report presents a histologically confirmed IVPG localised in the right external jugular vein, which has been present for 2 years and is progressively enlarging.

Cerebellar Venous Hemangioma: Two Case Reports and Literature Review

Venous hemangiomas within the central nervous system (CNS) represent a rare pathological entity described by sporadic case reports so far. Comprehensive insights into their histological and imaging features, pathogenesis, natural course, and therapeutic modalities are lacking. This review article presents two patients with contrast-enhancing cerebellar lesions near the tentorium cerebelli lacking edema or diffusion restriction. Despite meticulous preoperative neuroradiological examination, diagnostic classification remained inconclusive. Confronted with both—progressive size and diagnostic uncertainty—surgical intervention was undertaken, resulting in uneventful and complete resection of the lesions. Histopathological analyses subsequently revealed a venous hemangioma in each case. In the literature, the term “hemangioma” is often misapplied and inaccurately used to describe a broad spectrum of vascular anomalies. Therefore, a precise identification is essential since the particular type of vascular anomaly affects its natural course and the treatment options available. We aim to contribute to the understanding of this diagnostically intricate entity by presenting the two cases and by providing a detailed overview of radiological and histopathological features of venous hemangiomas.

Commentary on “Beyond infantile hemangiomas: A glimpse into overlapping rare syndromes emphasizing the vigilant screening for PHACE and LUMBAR syndromes”

Due to their complex etiology and pathogenesis, hemangioma-related syndromes, such as LUMBAR and PHACE, present diagnostic and therapeutic challenges. Despite advances, standardized diagnostic criteria, screening protocols, and treatment options still need to be developed. We report a rare case of a 1-month-old patient with nonspecific symptoms, including failure to thrive and poor feeding, associated with lumbosacral ulcers. The diagnosis revealed overlapping features of LUMBAR and PHACE syndromes, highlighting the broad phenotypic spectrum and suggesting a potential common etiology. This case underscores the need for heightened clinical suspicion among general practitioners, dermatologists, and vascular physicians to manage these conditions. Propranolol is widely used for treating infantile hemangiomas, but due to its side effects, alternative therapies need to be explored. Emerging treatments, such as Atenolol, Timolol, Carteolol, and pulsed dye lasers, offer promise but require further investigation. However, the most crucial aspect is the need for ongoing research into the mechanisms of action, clinical applications, and side effects of current and alternative treatments. This research is essential for developing a comprehensive, safe management algorithm for both low- and high-risk infantile hemangiomas. It demands sustained engagement and commitment from the medical and research communities, ultimately improving patient outcomes and advancing medical knowledge.

Identifying Potential Diagnostic and Therapeutic Targets for Infantile Hemangioma Using WGCNA and Machine Learning Algorithms.

Infantile hemangioma (IH) is the most common benign vascular tumor during infancy and childhood and is characterized by abnormal vascular development. It is the most common vascular tumor and its related mechanisms and treatments remain a problem. IH-related biomarkers have been identified using transcriptome analysis and can be used to predict clinical outcomes. This study aimed to identify the key target genes for IH treatment and explore their possible roles in the IH pathophysiology. Gene records were acquired from the Gene Expression Omnibus database. Utilizing integrated weighted gene co-expression network examination, gene clusters were determined. Single-sample gene set enrichment analysis was performed to gauge immune infiltration. Essential genes were identified via Random Forest and Least Absolute Selection and Shrinkage Operator analyses. Ultimately, a set of five pivotal genes associated with the ailment was identified (NETO2, IDO1, KDR, MEG3, and TMSB15A). A nomogram for predicting IH diagnosis was constructed based on hub genes. The calibration curve showed valid agreement between the prediction and conclusion that the key genes in the model were clinically significant. Neuropilin and Tolloid-like 2 (NETO2) are closely associated with tumor development. The role value of NETO2 expression levels increased in hemangioma-derived endothelial cells (HemECs). After silencing NETO2, the growth and migration of cancer cells were significantly restrained. This study revealed the critical role of NETO2 in IH development, suggesting that targeting NETO2 may be effective in improving the therapeutic outcome of IH.

CD26 Is Differentially Expressed throughout the Life Cycle of Infantile Hemangiomas and Characterizes the Proliferative Phase.

Infantile hemangiomas (IHs) are benign vascular neoplasms of childhood (prevalence 5-10%) due to the abnormal proliferation of endothelial cells. IHs are characterized by a peculiar natural life cycle enclosing three phases: proliferative (≤12 months), involuting (≥13 months), and involuted (up to 4-7 years). The mechanisms underlying this neoplastic disease still remain uncovered. Twenty-seven IH tissue specimens (15 proliferative and 12 involuting) were subjected to hematoxylin and eosin staining and a panel of diagnostic markers by immunohistochemistry. WT1, nestin, CD133, and CD26 were also analyzed. Moreover, CD31pos/CD26pos proliferative hemangioma-derived endothelial cells (Hem-ECs) were freshly isolated, exposed to vildagliptin (a DPP-IV/CD26 inhibitor), and tested for cell survival and proliferation by MTT assay, FACS analysis, and Western blot assay. All IHs displayed positive CD31, GLUT1, WT1, and nestin immunostaining but were negative for D2-40. Increased endothelial cell proliferation in IH samples was documented by ki67 labeling. All endothelia of proliferative IHs were positive for CD26 (100%), while only 10 expressed CD133 (66.6%). Surprisingly, seven involuting IH samples (58.3%) exhibited coexisting proliferative and involuting aspects in the same hemangiomatous lesion. Importantly, proliferative areas were characterized by CD26 immunolabeling, at variance from involuting sites that were always CD26 negative. Finally, in vitro DPP-IV pharmacological inhibition by vildagliptin significantly reduced Hem-ECs proliferation through the modulation of ki67 and induced cell cycle arrest associated with the upregulation of p21 protein expression. Taken together, our findings suggest that CD26 might represent a reliable biomarker to detect proliferative sites and unveil non-regressive IHs after a 12-month life cycle.

Periorbital Intravenous Lobular Pyogenic Granulomas: A Case Report and Literature Review of This Peculiar Pathology.

Intravenous lobular pyogenic granuloma (ILPG) is a seldom-documented pathology in oculoplastic and orbital literature. This study aims to elucidate the clinical presentation and histopathologic findings surrounding periorbital ILPG through a case presentation and literature review. We describe a 42-year-old male with a palpable periorbital subcutaneous nodule that was subsequently diagnosed as ILPG on immunohistochemistry. A literature review was performed by searching articles in the PubMed/MEDLINE database using the keywords "periorbital intravenous lobular pyogenic granuloma," "periorbital intravenous pyogenic granuloma," or "periorbital intravenous capillary hemangioma." The literature review identified 6 patients presenting with similar subcutaneous nodules that were diagnosed as periorbital ILPGs. All patients, including the one in this study, were treated with local excision. Only 1 patient (1/7; 14.3%) noted pain while 5 experienced swelling or fluctuance (5/7; 71.4%). In patients with documented pathology reports, all ILPGs involved the angular vein (6/6; 100%). Of the 3 patients who had follow-ups at 2 to 7 years postexcision, none had recurrence. Histopathologic findings demonstrate an intravascular lobular tumor composed of capillaries with endothelial cells and pericytes. Marked reactivity to anti-Wilms tumor type 1 (WT-1) and anti-Smooth muscle actin was noted in the capillary structure. ILPG can be included on the differential for well-circumscribed, subcutaneous periocular masses. While the etiology of periorbital ILPG is unknown, most cases are managed with surgical excision, and recurrence appears to be uncommon. In sharing these cases and histopathologic underpinnings of periorbital ILPG, we endeavor to describe this peculiar pathology for oculoplastic and reconstructive surgeons.

Assessing Response Rates and Sleep Disorder Prevalence: Insights from a Propranolol Treatment Study for Infantile Haemangiomas.

Infantile haemangiomas (IHs) sometimes require treatment with propranolol. Sleep disturbances are the most frequently reported side effects. Monitoring adverse drug events necessitates repeated hospital visits, which can be challenging during a pandemic. To explore the effectiveness of a new electronic questionnaire in identifying sleep disturbances related to treatment with propranolol and potential confounding factors. To evaluate the response rate to the questionnaire. To report the proportion of patients on propranolol with sleep disturbances. In an observational, prospective cohort study, caregivers provided clinical information during ambulatory visits and via an electronic questionnaire after an 8-week treatment course with propranolol and at the time of treatment interruption. Adverse drug reaction reporting forms were assessed for causality. The questionnaire response rate was 91%, and the completion rate was 100%. A total of 59% of patients experienced sleep disturbances during propranolol treatment, which were considered adverse reactions. Sleep disorders were frequent during sleep regression phases and in subjects who fell asleep during physical contact with caregivers or bed-sharing with parents. The application of this questionnaire allows for identifying adverse sleep events associated with propranolol in IHs and potential confounders. Counselling on sleep hygiene is recommended before treatment onset.