Infantile Hemangioma Patients Research Articles

Comparative Outcomes of Propranolol Monotherapy and Combined Therapy with Intralesional Triamcinolone in Infantile Hemangioma

Background: Infantile Hemangiomas (IHs) are the most common vascular tumors of infancy. Oral propranolol has achieved great success in treating IHs since 2008. Recently combined oral propranolol with intralesional injection of Triamcinolone acetonide is the effective method of treatment for infantile Hemangioma with minimal adverse effects. Objectives: To observe the outcome of Propranolol monotherapy and combined therapy with intralesional Triamcinolone in Infantile Hemangioma. Materials and Methods: This prospective study was carried out in the Department of Pediatric Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, during the period from January 2018 to December 2019. It included 42 infantile hemangioma patients divided into two groups: Group A (21) treated with oral propranolol, and Group B (21) treated with oral propranolol plus intralesional triamcinolone acetonide. Patients were followed up at regular intervals for 6 months. Results: The data of two groups of patients with IH were compared in the study. The demographic variables, including median age, sex, size, type, and site of IH, were comparable between the two groups. This showed that pre-treatment complications were slightly higher in Group B but not significantly different. Superior size reduction was observed in Group B (71.4% vs. 38.1%), though the difference was not significant statistically. Group B had excellent color regression, which was significantly higher compared to the other group (90.5% vs. 9.5%, p < 0.001). The mean treatment cost was higher in Group B, which was 187.86. taka compared to 124.76. taka in Group A (P value was <0.001). In summary, Group B had better color regression of the pinprick but at a higher cost of treatment as compared to Group A, and other parameters were almost equal in both groups. Conclusion: Combined propranolol and intralesional Triamcinolone is more effective compared to propranolol alone in the treatment of IHs.

Hemangioma activity score evaluation in infantile hemangioma patients: a retrospective study

Introduction: Infantile hemangioma (IH) is a benign vascular tumor commonly found in children. Generally, no special therapy is required because spontaneous resolutions occur. However, in some cases, therapy is required due to the potential of complications. During therapy, the side effects and effectiveness of therapy must be evaluated. One of the assessment tools is the Hemangioma Activity Score (HAS). HAS is a simple and objective assessment to evaluate the successful treatment of IH by observing swelling, color, and ulceration. The use of HAS in Indonesia is still minimal. This study aims to evaluate HAS before and after therapy in IH patients at Dr. Soetomo General Academic Hospital and Surabaya Skin Centre. Methods: Twenty-seven patient medical records were selected based on the inclusion and exclusion criteria. This study is an analytic cross-sectional retrospective using consecutive sampling. The collected data were tested for suitability using Cohen's Kappa. Pre- and post-tests were carried out using the Shapiro-Wilk and Wilcoxon tests afterward. Results: Among 27 IH cases occurred in females (81.4%), with the youngest age of the patient being 1 month and the oldest being 8 years. The onset of lesions in all patients appeared before 1 year of age. The most frequent location for IH lesions was the facial area (51.8%), with a clinical manifestation being plaque (37%). The most common therapy used in this study was pulse dye laser (PDL) (48.1%). Analysis of the difference in HAS before and after therapy showed p value = 0.00, a statistically significant difference in HAS before and after therapy. Conclusions: The hemangioma activity score is an effective measurement tool for measuring the severity of IH and evaluating the effectiveness of therapy.

Apolipoprotein A-I Binding Protein Inhibits the Formation of Infantile Hemangioma through Cholesterol-Regulated Hypoxia-Inducible Factor 1α Activation

Infantile hemangioma (IH) is the most frequent vascular tumor of infancy with unclear pathogenesis, of which disordered angiogenesis is considered to involve IH formation. We previously found that apolipoprotein A-I binding protein (AIBP)-also known as NAXE (NAD (P)HX epimerase)-a regulator of cholesterol metabolism, plays a critical role in the pathological angiogenesis of mammals. Here, we found that AIBP had much lower expression levels in both IH patients' tissues and hemangioma endothelial cells (HemECs), compared to adjacent normal tissues and human dermal vascular endothelial cells (HDMECs), respectively. Knockout of NAXE by CRISPR-Cas9 in HemECs enhanced tube formation and migration, and NAXE overexpression impaired tube formation and migration of HemECs. Interestingly, AIBP suppressed the proliferation of HemECs in hypoxia. We then found that reduced expression of AIBP correlated with increased Hif1α levels in IH patients' tissues and HemECs. Further mechanistic investigation demonstrated that AIBP disrupted Hif1α signaling via cholesterol metabolism under hypoxia. Notably, AIBP significantly inhibited the development of IH in immunodeficient mice. Furthermore, using the validated mouse endothelial cell (EOMA) and NAXE-/- mouse models, we demonstrated that both endogenous AIBP from tumors and AIBP in the tumor microenvironment limit the formation of hemangioma. These findings suggested that AIBP was a player in the pathogenesis of IH and could be a potential pharmacological target for treating IH.

Direct to Surgery? Surgical Outcomes in Pediatric Patients With Facial Infantile Hemangioma: A Retrospective Case-Control Study

Background: The effects of medical pre-treatment prior to surgical excision of infantile hemangiomas (IH) remains understudied. We hypothesized that medical pretreatment may improve outcomes after surgical excision. This study aimed to evaluate the difference in surgical outcomes/complications between direct to surgery (NPT) versus medical pre-treatment prior to surgery (PT). Methods: A retrospective study was conducted at a pediatric tertiary center between 2007 and 2018. Children 0 and 18 years who underwent surgical resection (confirmed GLUT-1 positive IH) were included. Visceral and congenital hemangiomas, PHACE, and vascular malformations/neoplasms were excluded. Pre-treatment was the primary predictor for post-surgical complications. Literature meta-analysis was also performed. Results: Our institution identified 185 IH patients, 85 (46%) underwent surgical resection. Of these, n = 28, (32.9%) had pre-treatment (PT) (8.24% propranolol, 9.41% topical timolol, 12.94% steroids, 2.35% laser); n = 57, (67.1%) had no pre-treatment (NPT). Pre-surgical lesion size was comparable ( P = .829). Surgical outcomes between PT and NPT were comparable for wound dehiscence, infection, scarring, and repeat surgery ( P = .162, 1.0, 1.0, 0.483), including pooled complications ( P = .448). Where documented, PT had higher functional improvement ( P = .039). Results were comparable when selecting for beta-blockers versus NPT. Meta-analysis included 7 studies and 169 patients, 39.1% PT and 68.1% NPT. The most common PT was systemic/intralesional steroids. Five received beta-blockers. All patients had functional improvement where recorded. Complications were slightly higher for PT ( P = .041). Conclusion: The incidence of surgical complications is comparable between direct to surgery and medical pre-treatment patients. Early surgical management without pre-treatment was not associated with improved complications/outcomes except select subgroup analysis identified improved functional outcomes with pre-treatment. Future directions include defining appropriate candidates for early direct to surgery versus best candidates for medical pre-treatment using patient specific variables.

The Profiles of Infantile Hemangiomas Patients

Background: Infantile hemangiomas (IH) are the most prevalent benign tumors in children, predominantly in girls. Most IH cases do not require treatment due to spontaneous involution, but 10% of cases do require early treatment due to size, location, and complications. Purpose: This study tried to define the profile, clinical aspects, and therapy of IH in Dr. Zainoel Abidin General Hospital, Banda Aceh. Methods: A descriptive approach using a retrospective analysis employing secondary data from the outpatient clinic's patient registration book. This study included all new cases of infantile hemangioma at the outpatient clinic general hospital between 2013 and 2021. Result: A total of 105 patients were involved in this study. The majority of IH patients (59%) were under the age of one year, with 64 female patients (61%) making the most visits to the pediatric clinic in 2017, 2018, and 2019 (77.1%). The most prevalent clinical features of skin lesions were nodules in 69 individuals (65.7%), and the most common site was the facial region (13.3%) in 44 patients. In 20 individuals, a combination of propanolol and oral corticosteroids was used as the most effective treatment strategy (19% ). Conclusion: Infantile hemangiomas is the most frequently reported benign tumor in children. Females are more likely than males to develop IH. The majority of IH is minor and normally resolves on its own without therapy. However, certain rare kinds of IH require clinician attention and systematic treatment.

Can Propranolol Affect Platelet Indices in Infantile Hemangioma?

Propranolol, a nonselective beta-blocker used in the medical treatment of infantile Hemangioma (IH), has been shown to decrease the levels of vascular endothelial growth factor and reduce angiogenesis with its antiproliferative and antiangiogenetic effects. It has been reported that the storage, transport, and secretion of vascular endothelial growth factor (VEGF) are associated with platelet volume indices (PVI). We aimed to investigate the effect of propranolol on PVI in IH patients. Propranolol treatment was started on 22 IH patients. Platelets, mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit values in the follow-ups at months 0, 1, and 2 were compared between 22 patients who received treatment and 25 patients who did not. While a statistically significant difference between months 0, 1, and 2 in PDW and MPV values was detected in the treated group, it was not detected in the untreated group. Taking into consideration that VEGF levels were higher at the beginning of the treatment in the pathophysiology of the disease, it was thought that the decrease in VEGF levels by propranolol may have led to a decrease in MPV and PDW levels in the treatment group. Consequently, in IH cases, propranolol response follow-up can be evaluated with PVIs, especially MPV and PDW, and it may facilitate clinicians' monitoring of the disease after propranolol administration.

Efficacy and Safety of Introduction Timolol Maleate by Manometer Microneedles among Infantile Hemangioma: A Retrospective Study in China.

The objective of the study was to compare the effective rate, cure rate, adverse reaction rate, and effective time of three methods in the treatment of infantile hemangioma, hoping to provide reference for improving the clinical therapeutic effect. This is a retrospective study of 307 infantile hemangioma patients admitted to the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, from January 2014 to October 2021. The patients were divided into three groups. In group A, timolol maleate solution was introduced by the nano-microneedle technique (97 cases); in group B, timolol maleate drops dipped in medical swabs were applied (107 cases); and group C patients took propranolol orally (103 cases). The effective rate, cure rate, adverse reaction rate, and effective time of treatment were recorded and compared. The total effective rate, total cure rate, and total adverse reaction rate of the three groups were 87.6, 65.2, and 9.4%, respectively. The results showed that the effective and cure rates of group A were higher than those of group B (92.8 and 76.3%, respectively; p < 0.05), the adverse reaction rate of group C was higher than that of group B (17.5%, p < 0.05), and the effective time of group A was shorter than that of groups B and C. In most patients, symptoms significantly improved within 2 months (p < 0.05). Timolol maleate introduced by nanometer microneedles is an effective and safe treatment for superficial hemangioma in infants with the highest effective and cure rates, lower incidence of adverse reactions, and the shortest effective treatment time.

Oralni topikalni timolol maleat ili oralni propranolol u lečenju infantilnih hemangioma: klinička analiza 403 pacijenta

Objective: Infantile hemangiomas (IH) are the most common benign vascular tumors of infancy. Propranolol (P), a nonselective beta-blocker, has been successfully used in managing IHs. Ongoing studies investigate the efficacy of the topical b-antagonist timolol maleate (TM) in IHs. The aim of this study is to assess the effects of interventions for managing infantile hemangiomas in children. Material and Methods: We retrospectively reviewed a total of 403 IH patients from March 2021 to March 2022. The patients were stratified into three groups. Patients in Group 1 were given TM at a dose of one drop topically twice a day, 0.5%. Patients in Group 2 were given P at a dose of 1 mg/kg twice a day. The patients in Group 3 did not receive any treatment, and observation was conducted solely by contacting the controls. Results: The median age of diagnosis was 5 months (range 0-60), with 57.1% of the cases being male. While TM treatment was applied to 32% of the children and P treatment was applied to 46.9% of the children, no treatment was administered in 21.1%. The most common location of hemangiomas was the face, accounting for 39.2%. Hemangiomas were observed in more than one location in 48 (12%) children. The median follow-up period for the patients was 4 months (range 0-28). Hemangiomas remained unchanged in 28.3% of all cases, shrank in 60.3%, and continued to grow in 11.4%. The primary indication for initiating TM was superficial hemangiomas and infants younger than 6 months. The leading reason for starting P significantly higher than in the other groups (p : 0.001). No statistically significant differences were observed between the groups regarding bleeding and ulceration rates (p &gt; 0.05). Conclusion: The efficacy of propranolol in treating IH was higher than that of TM.

Early propranolol treatment of infantile hemangiomas improves outcome

BackgroundInfantile hemangiomas (IH) are the most common soft tissue tumors of childhood. Although most of these tumors are not worrisome, some IH may be life or function-threatening, can lead to permanent disfigurement, or have associated structural congenital anomalies, requiring early recognition and referral to specialists for treatment consideration. Since 2008, oral propranolol has been widely considered to be the first-line treatment for IH. ObjectivesTo evaluate aesthetic and functional outcome in propranolol-treated infantile hemangiomas according to the age of treatment onset. MethodsRetrospective, observational study of infantile hemangioma patients under 4 years of age at the time of diagnosis, treated with oral propranolol. Evaluated parameters included: pre and post-treatment morphologic/aesthetic aspects of the hemangioma, total resolution rate, degree of functional compromise of affected areas and its evolution. Two independent pediatric dermatologists evaluated all cases reviewing clinical data from medical records and comparing clinical photographs taken at initiation and at the end of treatment of each patient. Data were analyzed with STATA 13.0 program. ResultsThe cohort included 138 patients, with a female predominance. The median age at therapy onset was 3 months. The morphological/aesthetic improvement rate was 99% (95% CI 96‒99), the total resolution rate was 48% (95% CI 44‒60) and the functional improvement rate reached 100%. When comparing total resolution outcome versus age when treatment started, the improvement was larger in younger patients (3.5 vs. 4.9 months, p = 0.01). When comparing the total resolution rate in those younger or older than 3 months at treatment initiation, the percentage of total resolution in the younger group was 57% vs. 40% in the older one (p = 0.05). Study limitationsRetrospective design; patients photographs were the sole indicators used to measure regression rates. Visual assessment is subjective. ConclusionThe present results strongly suggest that early (before 3 months of age) initiation of treatment of infantile hemangiomas with propranolol results in significantly higher aesthetic and functional improvement rates and a higher percentage of total resolution.

Analysis of Therapeutic Decisions for Infantile Hemangiomas: A Prospective Study Comparing the Hemangioma Severity Scale with the Infantile Hemangioma Referral Score.

In view of the high incidence of infantile hemangioma (IH) in infants and young children, a comprehensive and reasonable evaluation scale for referral is urgently needed. This study compared the influence of the Hemangioma Severity Scale (HSS) and the Infantile Hemangioma Referral Score (IHReS) on treatment decisions for infantile hemangioma patients. We aimed to establish a reliable and effective evaluation method for referral. This was a prospective study to determine whether treatment was needed for IH patients after evaluation with the HSS and IHReS. A total of 266 consecutive referred IH patients were evaluated for the risk of IH, and the treatment rate was 80.8%. The area under the curve (AUC) of the subject receiver operating characteristic curve (ROC) of treatment decision making after referral by the HSS was 0.703 (95% CI: 0.634-0.772), and after referral by the IHReS was 0.892 (95% CI: 0.824-0.960). This was a single-center study. For decisions regarding the treatment of IH patients, the IHReS has a higher efficiency and sensitivity than the HSS. However, the specificity of the IHReS is lower than that of the HSS.

356 Infantile hemangioma referral delays persist despite 2019 American Academy of Pediatrics Clinical Practice Guideline: Experience at a single quaternary pediatric institution

Infantile hemangiomas (IH) are vascular tumors that often require timely treatment to reduce morbidity.1,2 The 2019 American Academy of Pediatrics (AAP) Clinical Practice Guidelines (CPG) for the Management of IH recommend referral to dermatology prior to 4 weeks of age, enabling timely treatment initiation.1 This study examines adherence to national guidelines and aims to identify barriers to appropriate referral timing & treatment. This retrospective cohort study examined IH patients, ages 0 to 24 months, referred to Phoenix Children’s Hospital (PCH) Dermatology from 1/1/2019 to 12/31/2020, following release of AAP CPG.

Risk factors of long-term alopecia after pulsed-dye laser treatment for infantile scalp hemangiomas: A retrospective study.

Pulsed-dye laser (PDL), as an effective and frequently-used treatment modality for infantile hemangiomas (IH), could render patients at risk of developing long-term alopecia. Data on alopecia caused by PDL treatment remain scant and the contributing factors are not clear. Our objective was to identify the risk factors associated with long-term alopecia resulting from PDL treatment for scalp IH. We conducted a retrospective study incorporating patients with IH diagnosis and PDL intervention via thoroughly reviewing the clinical database of the dermatology department. Scalp IH patients were further screened and their medical records were collected. Long-term alopecia was defined as no signs of terminal hair regrowth for at least 2years in this study. Of the 1293 IH patients, 47 (14 boys and 33 girls) with a mean age of 4.5months (standard deviation, 3.2) were diagnosed as scalp IH and had subsequently undergone PDL treatments. Hair growth in the treatment area of 18 patients (38.3%) nearly returned to normal, 22 patients (46.8%) had varying degrees of hair loss, and seven patients (14.9%) had no hair regrowth (long-term alopecia). Compared with the older patients receiving treatment, IH patients younger than 3months who started PDL treatment had a higher risk of developing long-term alopecia (odds ratio, 30.833; 95% confidence interval, 4.079-232.025; p=0.01). The total number of PDL sessions, post-treatment blisters, and location of IH were not shown to be significantly associated with the development of long-term alopecia. Collectively, our study provides an important insight into curating treatments for IH in infants younger than 3months. PDL treatments for scalp IH may perhaps be avoided or delayed to prevent the development of treatment-associated long-term alopecia.

Long non-coding RNA breast cancer-associated transcript 54 sponges microRNA-1269b to suppress the proliferation of hemangioma-derived endothelial cells

ABSTRACT Long non-coding RNA (lncRNA) breast cancer-associated transcript 54 (BRCAT54) and microRNA-1269b (miR-1269b) are two critical ncRNAs in cancer biology, while their roles in hemangioma are unknown. Our preliminary sequencing data revealed their altered expression in hemangioma and predicted they could interact with each other. This study was therefore carried out to investigate the roles of BRCAT54 and miR-1269b in hemangioma, with a focus on their interaction. In this study, hemangioma samples donated by 20 infantile hemangioma patients at proliferating-phase and 20 infantile hemangioma patients at involuting-phase were used. The expression of BRCAT54 and miR-1269b in hemangioma samples, as well as hemangioma-derived endothelial cells (HDECs) and human umbilical vein endothelial cells (HUVECs) were detected by RT-qPCR. IntaRNA 2.0 was applied to predict the interaction between BRCAT54 and miR-1269b, which was then confirmed by RNA-RNA pulldown assay. Accumulation of BRCAT54 in the subcellular location of HDECs was detected by subcellular fractionation assay. The role of BRCAT54 and miR-1269b in cell proliferation has been explored by the BrdU assay. Compared to proliferating-phase tissues, involuting-phase tissues exhibited decreased expression levels of BRCAT54 and increased expression levels of miR-1269b. HDECs had decreased expression levels of BRCAT54 and increased expression levels of miR-1269b compared to that of HUVECs. In HDECs, BRCAT54, which was detected in both nuclear and cytoplasm fractions, directly interacted with miR-1269b. BRCAT54 and miR-1269b did not affect the expression of each other, while BRCAT54 suppressed the role of miR-1269b in enhancing the proliferation of HDECs. BRCAT54 may sponge miR-1269b to suppress the proliferation of HDECs.

Propranolol-induced hyperkalemia in infantile hemangioma patients: How serious is it?

Infantile hemangioma is the most frequent benign vascular tumor of infancy, which has a specific clinical history of early growth, followed by spontaneous remission. Since the fortuitous discovery of propranolol's efficacy in 2008, the management of infantile hemangioma has been quickly developing. This study is a retrospective cohort study. Electronic search in the patient's registry of King Khalid University Hospital, Riyadh, Saudi Arabia, was performed using the keywords hemangioma, haemangioma, infantile hemangioma, and vascular tumors. The search revealed a total of 101 subjects for which 56 were included and 45 were excluded. A total of 56 patients with infantile hemangioma were evaluated in this study. The majority were females. The F: M ratio is 3.4:1. The highest percentage of the patients was delivered by the elective cesarian section, that is, 23 (41.1%), followed by spontaneous vaginal delivery, that is, 19 (33.9%). Full-term patients were 27 (48%), whereas the pre-term patients were 21 (37%). The total number of patients who developed hyperkalemia while on propranolol was 12 (31%). There was no statistically significant difference (P > 0.05) between patients who developed hyperkalemia and patients who did not develop hyperkalemia in terms of gender, gestational age, mode of delivery, size and location of hemangioma, or concomitant topical timolol use. Hyperkalemia is benign and transient, although solid conclusive opinions cannot be drawn because of the small sample size and the retrospective nature of the study.

Good Clinical Responders to Topical Timolol in Patients with Infantile Hemangiomas: A 7-Year Retrospective Study of 328 Korean Patients.

BackgroundTopical timolol is widely used for treatment of superficial infantile hemangioma (IH). However, little is known about factors that affect the response to topical timolol treatment.ObjectiveThis study aimed to investigate the efficacy, safety, and predictive value for good response to topical timolol for IH.MethodsA retrospective review of medical records and clinical photos of 328 patients with IH treated with topical timolol 0.5% solution was conducted. Serial clinical photographs were compared with those at the initial visit using a 100-mm visual analogue scale (VAS). Treatment response was defined as an improvement of at least 75% from baseline in IH lesions within 12 months of treatment.ResultsOverall, IH patients treated with topical timolol showed significant improvement from baseline, showing that the final VAS score within 12 months of treatment was 69.7±20.4. The multivariable logistic regression analysis showed age at initiation of treatment (p=0.007), length of gestation and fetal growth (p=0.03), depth (p=0.01), and flexural area (p=0.007) were significantly associated with treatment response. Only four patients (1.1%) reported local irritation.ConclusionThis study demonstrated that topical timolol treatment was an effective and well-tolerated treatment for IHs. Physicians are encouraged to consider several patient- or lesional factors that might affect treatment response to achieve better clinical outcomes.

LncRNA-MCM3AP-AS1 Promotes the Progression of Infantile Hemangiomas by Increasing miR-138-5p/HIF-1α Axis-Regulated Glycolysis.

Infantile hemangioma (IH) is a common benign tumor of endothelial cells in infants. Most hemangiomas are self-limited, but a few may develop and lead to serious complications that affect the normal life of children. Therefore, finding an effective treatment strategy for IH is a pressing need. Recent studies have demonstrated that non-coding RNAs affect the progression of multiple tumors. This study aims to investigate the mechanism by which LncRNA-MCM3AP-AS1 promotes glycolysis in the pathogenesis of IH. We first documented that the expression of LncRNA MCM3AP-AS1 was significantly upregulated in IH. Furthermore, we demonstrated that MCM3AP-AS1 bound to miR-106b-3p which promotes glycolysis in IH. In addition, we found that inhibition of HIF-1α contributed to the transformation of glycolysis to normal aerobic oxidation, partially reversed the promoting effect on glycolysis by the up-regulation of LncRNA MCM3AP-AS1 in IH disease. More importantly, we demonstrated this phenomenon existed in IH patients. Taken together, we demonstrate that LncRNA-MCM3AP-AS1 promotes the progression of infantile hemangiomas by increasing the glycolysis via regulating miR-138-5p/HIF-1α axis.

МЕЖДИСЦИПЛИНАРНЫЙ ПОДХОД К ЛЕЧЕНИЮ МЛАДЕНЧЕСКИХ ГЕМАНГИОМ

The aim of the study is to find the best approaches to the treatment of infantile hemangiomas (IH). Materials and methods of research: the experience of treatment of pediatric patients with IH of various localization is presented, which was carried out according to the protocol elaborated by the authors. Systemic therapy with propranolol, local therapy, laser therapy were used in the complex of treatment. The age of patients at the beginning of therapy ranged from 1 month up to 4,5 years. Results: in all cases, patients with propranolol treatment showed a quick and stable effect. Even at the time of the selection of the dose of the drug, IH patients began to involute, became paler, less tense. The thickness of the soft tissues in the IH area decreased by 65% compared to the baseline, the number of functioning vessels decreased by 86%. The maximum effect was achieved within the first 6 months from the start of therapy. Clinical case report – a 2,5-year-old child with extensive hemangioma of the right buttock. There was a complex treatment with propranolol, local therapy, laser therapy. The general course of treatment with propranolol was 2 years 8 months. The total number of laser interventions was 6 with the overall effect in the form of maximum regression of residual clinical manifestations of IH. A positive clinical and ultrasound picture was noted, indicating a pronounced involution of IH, and a gradual withdrawal of propranolol was started. Conclusion: the effectiveness of a comprehensive interdisciplinary approach to the treatment of extensive complicated IH was demonstrated with the participation of specialists of various disciplines: pediatricians, cardiologists, surgeons, specialists in functional and ultrasound diagnostics, specialists in laser therapy, endocrinologists in a severe premature baby with a large number of somatic problems. The clinical treatment algorithm developed and implemented for patients with IH makes it possible to avoid more aggressive methods of treatment of this pathology and to improve the quality of life of this category of patients. On the basis on the results obtained, indications for laser therapy with a selective pulsed laser were formulated.

Evaluation of plasma and urinary levels of vascular endothelial growth factor and matrix metalloproteinase-9 in patients with infantile hemangioma.

The pathogenesis of infantile hemangioma (IH) is not fully understood. It has been suggested that angiogenic factors increase in the proliferative stage, decreasing subsequently in the regression phase. To evaluate vascular endothelial growth factor (VEGF) and matrix metalloproteinase 9 (MMP-9) levels, according to infantile hemangioma (IH) growth stages and size, and to compare these levels in patients with IH and control subjects. This cross-sectional study included 68 patients with IH and 25 control subjects. Plasma and urinary MMP-9 and VEGF levels were evaluated during proliferative and regression phases. These levels were correlated with tumor size measured by ultrasonography. Nonparametric tests were performed. Among 68 patients with IH, 55 (81%) were female. Age ranged from 1 to 40months (median 7.0months). There was no difference in plasma and urinary levels of VEGF and MMP-9 between patients and control subjects. There were no significant differences in these levels between IH patients younger or older than 12months of age, as a cutoff between proliferative and involution phases. No significant correlation was observed between tumor size and levels of the markers (R<0.20 and P>0.05 for all comparisons). In our large sample, levels of VEGF and MMP-9 did not reflect the characteristic increased angiogenesis in patients with IH when compared to healthy subjects. In addition, these markers were not increased in the proliferative stage of the IH and did not correlate with tumor size.

Oral atenolol treatment for infantile hemangiomas: clinical analysis of 133 consecutive patients.

BackgroundInfantile hemangiomas (IHs) are the most frequently occurring pediatric lesions. Oral propranolol has been shown to be safe and effective in infants with IHs. Side effects such as sleep disturbances have been associated with propranolol. Atenolol is a hydrophilic, selective β1-blocker and therefore may be not associated with side effects attributable to β2-adrenergic receptor blockade and lipophilicity. However, the efficacy of atenolol in the treatment of IHs is poorly understood. The aim of this study was to evaluate the efficacy of atenolol in the treatment of proliferating IHs in a clinical cohort including 133 consecutive patients.MethodsIn this study, we enrolled 133 patients diagnosed as proliferating IHs from the routine clinical and referral practices of the authors. The procedures followed were in accordance with the ethical standards of the Institute Review Board of Shanghai Ninth People’s Hospital and Helsinki Declaration. Clinical characteristics, including demographic data and clinical morphology, were collated. Responses to oral atenolol therapy were graded as: excellent, good, fair and poor. According to the reaction to atenolol treatment, additional medications or therapy were used for IH patients to achieve satisfactory clinical results.ResultsIn this study, 128 (96.2%) of 133 IH patients responded to oral atenolol, and the response rate (RR) was significantly different for different ages of patients (P<0.05), with the youngest patients having the highest RR. The mean time of treatment was 4.9 months. Forty-one patients who exhibited residual hyperpigmentation or telangiectasia were further treated with timolol maleate cream (n=32) or pulsed dye laser (n=9). All the 41 patients showed positive response. No life-threatening complications were noted during and after oral atenolol. Only 4 (3.0%) of 133 patients developed minor complications including diarrhea. No agitation and bronchospasm were noted in our study.ConclusionsThis study demonstrated that atenolol was effective in the treatment of IHs. Compared to propranolol, atenolol seems to have a similar effect on IHs. Furthermore, atenolol seems to be less frequently associated with potentially life-threatening side effects.

Evaluation of Clinical Properties and Treatment Responses of Infantile Hemangioma.

Infantile hemangiomas are the most common vascular tumors in childhood. Although spontaneous regression is common; several infantile hemangioma patients need treatment due to possible morbidities. The aim of this study was to investigate the medical methods used in the treatment of infantile hemangiomas and to evaluate the factors affecting treatment response. Clinical and demographic characteristics, risk factors, treatment indications, modalities, duration, and responses of 100 patients between January 2007 and January 2017 were evaluated. The most common form of hemangiomas was superficial lesions. Sixty three per cent of the patients were female. Ulceration and hemorrhage were found in 26% of the cases and ocular problems were detected in 3% of the cases. Among the indications for treatment were cosmetic reasons with 56%, ulcer and bleeding with 25% and risk of vision problems with 13%. Propranolol with/without steroid was used as first line treatment and response rates were: 84 patients with more than 50% response, 9 patients with less than 50% response and 7 patients with treatment refractory. The most important factor affecting the treatment response was age at the beginning of the treatment. Duration of treatment, presence of ulceration, location, and size of hemangioma were also found to have significant effects on responses. This study demonstrated the importance of the kind and initiation time of infantile hemangioma treatment. A strong positive effect can be reached by starting treatment before the end of the proliferation phase. J Drugs Dermatol. 2020;19(12): doi:10.36849/JDD.2020.5009.