Periorbital Hemangiomas Research Articles

β-blockers in the treatment of periocular infantile hemangioma.

To evaluate the medical literature on the use of β-blockers, through different routes, for the treatment of periorbital infantile hemangiomas and to summarize the recommendations available on dosage and monitoring. β-blockers for the treatment of infantile hemangioma are now considered to be first-line treatment. Growing literature on the role of oral propranolol confirmed its efficacy but also presented its multiple side-effects including hypotension, bradycardia, hypoglycemia, and bronchospasm. No universal guidelines exist concerning pretreatment evaluation, dosage, monitoring, and duration of treatment but different protocols have been created.In the aim of minimizing side-effects, other routes of administration and more selective β-blockers have emerged. Many studies showed promising results for topical timolol especially in the treatment of superficial hemangiomas. Few studies evaluated intralesional propranolol. Limited data exist on the use of more selective β-blockers promising similar results to propranolol with fewer side-effects. Oral β-blockers are now the mainstay of treatment for periorbital hemangiomas but still with no consensus on their administration and monitoring. The topical form or more selective β-blockers may be the solution to minimize side-effects.

Management of infantile periorbital hemangiomas: a revisit

Background Although infantile hemangioma is a common benign childhood tumor, it is still one of the challenging problems. Aim The current prospective study aimed to evaluate the effect of local propranolol gel in the treatment of infantile periorbital hemangioma. Patients and methods A prospective study in the period of 4 years from January 2012 to December 2016 was carried out on infants with periorbital hemangioma with a follow-up period of a minimum of 1 year. All infants underwent a fine-needle histopathological sample. All patients who proved to be capillary hemangioma were divided into two groups. Group I included those patients who were treated with topical timolol maleate gel from 4 to 30 weeks. On the other hand, group II included those patients who underwent a local corticosteroid therapy in the form of clobetasol 0.05% gel for a similar period. Posttherapy clinical and histopathological assessment took place in both groups. The obtained data were statistically analyzed. Results Twenty-eight patients were enrolled in the study. They were 18 women and 10 men with the ratio of women to men being about 2 : 1. In 21 infants, the tumor shrank in a period of 4–10 weeks after topical timolol administration. On the other hand, those who underwent local corticosteroid therapy showed a longer period for the shrinkage of the tumor; the P value is less than 0.003. Conclusion Local timolol gel therapy is superior to topical corticosteroid therapy with a wide range of safety and less side effects. Moreover, its cost-effectiveness is acceptable compared with other modalities such as laser therapy. The number of the study materials are limited; yet, it may be an indicator for a road map of managing infantile periorbital hemangiomas. Further studies with a larger population may be needed, as the problem deserves a full citizenship in the world of pediatric research.

SAT-285 Role of Chromosome Microarray in Identifying a Genetic Cause of Undervirilized External Genitalia and Growth Delay in an Infant: 6p Duplication Associated with Short Stature and Micropenis

THE CASE 4 mo M born at term 7lbs 7.5oz, 19.5 inches via C-section, referred for micropenis found during evaluation for circumcision. No history of hypoglycemia. Of note, dad is s/p hypospadias repair and is short at 5th %ile. PE showed short stature, length at 3rd %ile (-1.91 SDS), wt 53rd %ile, HC 76th %ile. Stretched penile length 1.5 cm (-2.5 SDS = 1.9cm), testes 1.5 cm each, normal. Periorbital hemangioma noted. Otherwise normal exam. Chromosome microarray showed a 6.1 Mb duplication of the terminal region of 6p, pathogenic; and a 222 kb deletion of terminal 17p (felt to have no clinical significance). Patient referred to Genetics. Parental testing showed balanced translocation in dad's chromosome 46,XY,t(6;17)(p25.1;p13.1)]. GH, TSH, FT4, LH, FSH, AMH levels normal. Total Testosterone 68 ng/dL. CAH-6 panel within expected limits. Testosterone therapy 50mg/mo x 3mos initiated to improve penile length. DISCUSSION Workup of underlying cause of male undervirilization is challenging. More often than not, a definitive diagnosis remains elusive. The current case underlines the invaluable contribution of chromosomal microarray in this endeavor. Duplication of distal fragment of chromosome 6p is extremely rare, with <50 cases reported thus far. There are several genes located in this region, and as expected, case reports thus far have a wide phenotypic variability. Common features include pre-/postnatal growth delay, developmental disability, congenital malformations of the heart, kidneys, eyes. However to our knowledge, this is the first report of a patient with 6p25pter with micropenis. Of note, a patient with 6p25pter + 22q11.2pter trisomies was reported to have penile chordee and cryptorchidism (Scarborough, et al, 1986). Patienit's dad has history of hypospadias as well, suggesting a correlation between this specific mutation and undervirilized male external genitalia. Review of 26 OMIM genes contained in the reported abnormal region showed scant known data about these genes. However, gene transcripts from 5 of these OMIM genes (DUSP22, FAM50B, HUS1B, FOXQ1, SERPINB9) were shown to be highly expressed in the testis +/- brain in humans/animals, suggesting a possible role that these genes play in male genital development. CONCLUSION A genetic cause of micropenis is often hard to establish. We report a case associated with a pathogenic duplication of the terminal region of 6p chromosome. To our knowledge, no such case has been previously reported. This rare chromosome abnormality does have other associated medical complications for which he needs to be monitored. The crucial role of chromosome microarray in picking up such abnormalities in workup of undevirilization is emphasized. More research is needed to elucidate the mechanism by which the affected genes influence male genital development.

Treatment of Periorbital Infantile Capillary Hemangioma with Propranolol

Treatment of Periorbital Infantile Capillary Hemangioma with Propranolol

Management of Infantile Periobital Hemangioma: a Prospective Study of a Single- Centre Experience from Saudi Arabia

Background: Although infantile hemangioma is a common benign childhood tumour, it is still a challenging entity in paediatric ophthalmology with many controversial lines of management. Management options include topical, intralesional or systemic steroids, surgical resection or even observation with no active intervention, as Hemangioma usually involutes after a period of growth. Aim: The current prospective study aimed to evaluate a single-centre experience in the management of infantile periorbital hemangioma in order to find a solution to the highly debated issue of the ideal management modality in this condition. Patients and Methods: A prospective study over a period of 4 years from January 2011 to December 2014 was carried out on infants diagnosed with periorbital hemangioma. The follow up period was one year from 2014 to 2015. All patients underwent a fine needle histopathological assessment before the start of treatment. All infants had one or more intralesional corticosteroid therapy, which was the first line of treatment in all cases. However, in 4 cases who did not show any improvement, systemic propranolol therapy was instituted. Results: Eighteen infants were enrolled in the study. There were 13 females and 5 males with the ratio of females to males being 2.6:1. In 11 infants, the tumor shrank within one week after the administration of intralesional glucocorticoids with the fading of tumor color. After one month of injection, the tumor was obviously involuted. The tumor became soft, flat and turned dark red. Two months after the injection, most of tumors continued to involute. Three of the tumors (17.7%), grew at the edge and required retreatment. Eleven patients underwent the treatment once, two patients twice, and one patient thrice. At the end of follow-up, tumors in 14 patients got almost completely involuted, with local telangiectasia left in 6 patients. In 3 patients, the tumor shrank, but did not completely involute. For effects evaluation, the treatment results were labeled as "markedly effective" in 12 cases and "effective" in 2 cases. Conclusions: Intralesional glucocorticoid therapy is a freely available, economic and effective therapy in the management of capillary periorbital hemangiomas, yet, in some cases of capillary hemangiomas, there is an indication for administering systemic propranolol therapy. The sample size is limited, yet, it may be the initial step in devising a road map for the management of infantile periorbital hemangiomas. It may also play a role in putting to rest a controversial topic in pediatric ophthalmology.

Clinical Outcomes of Infants With Periorbital Hemangiomas Treated With Oral Propranolol

Periorbital infantile hemangiomas (IHs) require early intervention because they have the potential risk of causing visual disturbances. In recent years, propranolol has shown promise in the effective management of periocular and periorbital IHs. The objective of our study was to assess the clinical outcomes, efficacy, and safety of propranolol in the management of infants with high-risk periorbital IHs. This retrospective study was conducted at the Stomatological Hospital affiliated with China Medical University. The medical records of infants with periorbital hemangiomas who were treated with systemic propranolol at a dose of 1.0 to 1.5mg/kg per day between January 2014 and June 2015 were reviewed. We excluded infants who did not qualify for propranolol treatment and infants who received previous therapy or other treatments. The records were reviewed for treatment response, adverse events during treatment, length of treatment, and recurrences. Treatment response was classified using a 4-point scale system based on reduction in volume as poor (<25%), moderate (25 to 50%), good (50to 75%), or excellent (>75 to 100%) and change in color, as well as surface texture, by a panel of 3 plastic surgeons using 2-dimensional photographs, clinical examination, and Doppler ultrasonography measurements taken before and after treatment. Of 38 infants with periorbital hemangiomas, 26 were treated with systemic propranolol at a dose of 1.0 to 1.5mg/kg administered once daily. A total of 11 male and 15 female infants with a mean age of 5.2months (range, 2 to 12months) were treated. The mean length of treatment was 22weeks (range, 4 to 41weeks). Adverse events of diarrhea (n= 3) and sleep changes (n= 1) were encountered during treatment in 4 patients. The overall treatment response was scored as excellent in 17 patients, good in 7, moderate in 2, and poor in 0. No patients required discontinuation of treatment because of adverse events, and there were no cases of recurrence or tumor regrowth noted during the mean follow-up period of 6.5months (range, 3 to 10months). Oral propranolol at a dose of 1.0 to 1.5mg/kg per day (age ≤3months, 1.0mg/kg; age>3months, 1.5mg/kg) was effective and well tolerated for the management of 26 Chinese infants with high-risk periorbital IHs. Early intervention should be considered to reduce risk of visual impairment and improve esthetic outcomes.

β-Blocker versus triamacinolone acetate in the treatment of infantile periocular hemangioma

Purpose The aim of this study was to evaluate the effectiveness of systemic and intralesional β-blockers in the treatment of periocular infantile capillary hemangiomas and to compare the effect of intralesional triamcinolone acetonoid injection and β-blockers. Patients and methods Totally, 60 patients with infantile periocular hemangioma were included in the study and were divided into three groups. Group 1 included 20 patients treated with systemic β-blocker. Group 2 included another 20 patients treated with intralesional triamcinolone acetate. Group 3 included 20 patients treated with intralesional β-blocker. Results In group 1, 55% of patients showed excellent response, 30% of patients showed good response, 10% of patients showed fair response, and 5% of patients showed poor response. In group 2, 50% of patients showed excellent response, 35% of patients showed good response, 15% of patients showed fair response, and no patients showed poor response. In group 3, 40% of patients showed excellent response, 25% of patients showed good response, 25% of patients showed fair response, and 10% of patients showed poor response. Conclusion Systemic propranolol is a good alternative for treating periorbital infantile hemangiomas. Systemic propranolol is superior to intralesional steroid because systemic propranolol has fewer side effects. Propranolol provides a more safe and effective modality of treatment of periocular infantile capillary hemangioma with a lower incidence of systemic side effects.

Comparative study between intralesional Dexamethasone and oral Prednisolone in the treatment of Infantile Hemangioma

Background: Infantile Hemangioma (IH) is one of the most common childhood neoplasm. Current treatments for children with endangering Infantile Hemangioma are limited, and include primarily oral corticosteroid which has many systemic adverse effects. Furthermore, approximately one third of IH does not respond to oral steroids, prompting active investigations for new treatments.Objective: To compare the efficacy, side effects, and influencing factors of oral Prednisolone and intralesional Dexamethasone (IL) in treatment of IH and thus to find out an effective, cheap and safe modality of treatment for this anomaly.Materials and Methods: This study was carried out on 48 patients of IH with the age range from 1 day to 12 years. Group A (n1=26) patients were treated by oral Prednisolone and group B (n2=22) patients were treated by IL Dexamethasone .Periorbital Hemangioma and IH &gt;54 cubic centimeter were excluded. Therapeutic response of Prednisolone and Dexamethasone was graded as excellent, good, poor and no response. We monitored volume of the lesion and its color change to evaluate the response to treatment.Results: Overall therapeutic responses were 69.2% in Group A and 68.2% in group B. Side effects were noted in 65.4% patient of group A and 36.4% patient of group B. In group A, the commonest (38.5%) side effect was excessive weight gain with cushingoid facies and in group B, commonest (27.3%) side effect was ulceration at injection site. Side effects were more in children of group A. Range of treatment was 4-20 weeks in group A and in group B, it was 4-24 weeks.Conclusion: IL Dexamethasone is effective as oral Prednisolone for treatment of IH .Unlike Prednisolone, IL Dexamethasone is devoid of systemic side effects.J. Paediatr. Surg. Bangladesh 5(1): 12-19, 2014 (January)

An atypical case of multifocal infantile haemangioma in a child after Highly Active Antiretroviral Therapy (HAART) during pregnancy

Haemangioma is a benign congenital vascular neoplasm, which ost commonly affects the skin [1]. It is the most common tumour f infancy, affecting approximately 10% of children under 1 year of ge. The use of HAART in pregnancy along with caesarean section nd formula feeding, has reduced the rate of vertical transmission f HIV from about 25% to 1–2%. However, it has been suggested that ntiretroviral drugs may have teratogenic effects [2] and may play role in the pathogenesis of haemangiomas [3]. We report here an atypical case of periorbital haemangioma ith response to corticosteroids, but persistent intracranial lesions onsistent with haemangioma and developmental cysts, in a AART exposed Caucasian Italian child, born to an HIV positive other.

Clinical review of periorbital capillary hemangioma of infancy

Clinical review of periorbital capillary hemangioma of infancy

Case report: Periorbital intraosseous hemangiomas

Hemangiomas are hamartomatous proliferation of vessels. Intraosseous hemangiomas of the facial bones are rare and most commonly involve the zygoma, maxilla, mandible, and the nasal bones. A “sunburst” pattern is a typical appearance on CT scan and MRI and therefore a biopsy is not always necessary. Surgery is usually performed in symptomatic cases. The authors describe five typical periorbital intraosseous hemangiomas with a brief review of literature.

Excision of Periorbital Hemangiomas to Correct Visual Abnormalities

To determine whether early surgical excision of complicated periorbital hemangiomas (CPHs) reversed refractive errors and prevented further visual complications; CPHs can cause visual complications including astigmatism, strabismus, and occlusion of the visual axis with resultant amblyopia. Retrospective review of patient series from a tertiary care pediatric referral center. Nine patients with CPHs were managed by otolaryngology and ophthalmology services with complete surgical excision. Preoperative eye examination findings were compared with postoperative findings. Comparison of preoperative and postoperative refraction measurements and/or eye examination findings indicated reduction of astigmatism and substantial improvement in vision as measured by refractive changes and reduction of pupillary occlusion. Total excision of CPHs is a safe and effective approach. When completed early, excision provides definitive therapy, reduces or eliminates astigmatism, and can prevent amblyopia in pediatric patients when pupillary occlusion is present.

Nonselective &amp;szlig;-blocker propranolol for orbital and periorbital hemangiomas in infants: a new first-line of treatment?

PurposeTo determine the effectiveness and possible side effects of using propranolol for the treatment of orbital and periorbital infantile hemangiomas.MethodsInfants with periorbital or orbital hemangiomas who had not received either local or systemic corticosteroids were recruited. The changes in tumor size, color, and texture, and any side effects of the drug were recorded.ResultsFifteen infants with a mean age of 8.13 ± 4.7 months were treated according to the set protocol. A change in the color and texture of the hemangioma occurred in the first week following treatment. Mean duration of treatment was 7.67 ± 3.96 months. The size of hemangiomas decreased from a mean of 2.4 ± 0.9 cm to a mean of 1.6 ± 1.0 cm 3 months after treatment (P = 0.001). One patient had to stop the drug because of peripheral vascular ischemia. Another case had the dose reduced to control a mild hyperglycemia. Serious side effects were not observed. A single case of tumor regrowth (8.3%) was recorded.ConclusionTreatment of 1–2 mg/kg/day propranolol proved to be effective and associated with minimal side effects. It is likely to replace steroids as the first-line of treatment of hemangiomas in infants.

Oral propranolol for the treatment of periorbital infantile hemangioma: A preliminary report from Oman

Purpose:To investigate the efficacy and safety of oral propranolol in the management of periorbital infantile hemangioma in four subjects.Materials and Methods:Consecutive patients who presented with periorbital capillary hemangioma with vision-threatening lesions were prospectively enrolled in this study between January 2009 and October 2010. All subjects underwent treatment with 2 mg/kg/day oral propranolol. All subjects underwent ocular, systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated.Results:Four subjects, between 3 months and 19 months of age, with periorbital hemangioma were enrolled in this study. Two subjects had been previously treated with oral corticosteroids with unsatisfactory response. All subjects had severe ptosis, with the potential for deprivation amblyopia. Three subjects had orbital involvement. After hospital admission, oral propranolol was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent therapy was performed with periodic out-patient monitoring. All subjects had excellent response to treatment, with regression of periorbital and orbital hemangioma. There were no side effects from therapy.Conclusions:Oral propranolol for periorbital hemangioma was effective in all the four subjects. Oral propranolol may be appropriate for patients who are nonresponsive to intralesional or systemic steroids. In patients with significant orbital involvement and lesions causing vision-threatening complications, oral propranolol can be the primary therapy.

Laser and other treatment options in the therapy of infantile capillary eyelid and periorbital hemangiomas: An overview

Hemangiomas in infancy generally require a multidisciplinary approach. As a result of their natural course, usually with spontaneous involution, a “watch-and-wait” strategy often seems to be sufficient. Nevertheless, in periorbital hemangiomas not only cosmetic but also functional aspects may require an early intervention. There are many treatment options such as steroids, surgery, cryotherapy, magnesium seeds and laser. The present paper focuses on the different types of laser used in the treatment of infantile capillary eyelid and periorbital hemangiomas. Die Behandlung kindlicher Hämangiome erfordert in der Regel eine multidisziplinäre Zusammenarbeit. Oft ist eine abwartende, beobachtende Haltung ausreichend, entsprechend dem natürlichen Verlauf mit meist spontaner Regression. Nichts desto trotz können kosmetische und vor allem funktionelle Einschränkungen dennoch eine frühzeitige Intervention erforderlich machen. Mögliche Therapieoptionen sind die lokale oder systemische Gabe von Steroiden, Kryotherapie, Magnesiumspickung und Laserbehandlung. Der vorliegende Artikel stellt insbesondere die verschiedenen Lasertypen und deren Anwendungsbereiche in der Behandlung von Augenlid- und periorbitalen Hämangiomen vor.

Propranolol in the management of periorbital infantile haemangioma

Infantile haemangiomas are the commonest tumours of the orbit in children. Treatment is usually expectant, unless they are visually threatening. Although steroids, other pharmacological and surgical treatment modalities have their place, there are risks involved. A previous case series reported the successful use of propranolol for infantile haemangioma. The safety and efficacy of propranolol in the treatment of periorbital haemangioma was reviewed in a serious of our patients. We performed a retrospective review of patients seen by two ophthalmologists (TJS and GAG), collecting data on colour, size of lesion, duration of treatment and side-effects of treatment. Our main outcome measures were colour and size of infantile haemangioma before and after treatment, the change in astigmatism of our patients and the incidence of complications from propranolol. We reviewed 10 patients with infantile haemangioma. They were treated with propranolol oral syrup 2 mg/kg/day in divided doses for a mean duration of 32.8 (range 12-42) weeks. All our patients had a reduction in colour and size of the lesions. The mean lesion size decreased from 756.7 to 543.2 mm(2) after treatment (P = 0.075). Five patients had significant astigmatism and 60% had successful reduction of astigmatism after treatment. None of our patients suffered significant side-effects of propranolol. Propranolol appears to be a safe and effective treatment in the management of infantile haemangioma.

Propranolol in the Management of Airway Infantile Hemangiomas

To report our experience with propranolol in managing airway infantile hemangiomas. Case series of 3 consecutive patients who had extensive, symptomatic airway infantile hemangiomas treated with propranolol. Tertiary academic medical center. Three infants with facial cutaneous hemangiomas who developed stridor that progressed to respiratory distress, which according to laryngoscopic examination results was confirmed to be caused by extensive subglottic hemangiomas. These patients underwent follow-up during their course of therapy, ranging from 3 weeks to 15 months. Patient 1 failed to respond to systemic corticosteroids, laser ablation, and intravenous vincristine for her airway hemangioma and had to undergo tracheotomy. She was given propranolol after her tracheotomy and had a significant reduction in her subglottic airway obstruction. Patient 2 developed progressive stridor secondary to airway hemangioma at age 6 1/2 months following tapering of systemic corticosteroids prescribed for her periorbital hemangioma. Systemic corticosteroids were restarted with the addition of propranolol. The stridor improved within 24 hours, and she was able to be weaned off corticosteroids. Patient 3 was also treated with initial combined therapy of systemic corticosteroids and propranolol. He had a significant reduction in stridor within 24 hours and was weaned off corticosteroids. Our 3 patients had severe respiratory symptoms related to their airway infantile hemangiomas. In the first patient, propranolol was used when other treatments were ineffective or associated with intolerable adverse effects. In the second and third patients, propranolol was part of a dual regimen that resulted in rapid resolution of airway symptoms and allowed for quicker weaning of corticosteroids.

A Case of Periorbital Infantile Capillary Hemangioma Treated With Propranolol

Purpose: To report a case of periorbital infantile capillary hemangioma treated with propranolol. Case summary: A 6-month-old girl visited our clinic for a mass on the right upper eyelid, which had been present since birth. A dome-shaped, red-purple colored mass occupying almost the entire right upper eyelid was observed, and overlying branch-shaped telangiectases were also detected. The visual axis of the right eye was partially obscured, due to the ptotic eyelid, and her ability to fix and follow was poor in the right eye. The patient was diagnosed with infantile capillary hemagioma. Because amblyopia in her right eye was suspected, treatment with propranolol was initiated. After 2.5 months of propranolol treatment, the hemangioma decreased in size and volume dramatically, changed from red-purple to light red color, and softened. The ptosis of the right upper eyelid improved, as well as the ability of the right eye to fix and follow. No significant adverse effects (e.g. hypotension, bradycardia, hypoglycemia, bronchospasm, or elevated liver enzymes) were observed, except transient QTc prolongation during cotreatment with ibuprofen, due to an upper respiratory infection. Conclusions: Propranolol should be considered as a treatment option for periorbital infantile capillary hemangioma. Further clinical studies are required to establish the optimal guidelines and long-term outcome.

Update on Intralesional Steroid: Focus on Dermatoses

Intralesional steroid (ILS; usually triamcinolone acetonide) is commonly used, and the literature contains much information about its use in keloids, hemangiomas, and alopecia areata. Little has been written about its use in inflammatory dermatoses such as psoriasis and localized dermatitis since the 1960s, the conditions for which it was originally most studied and used. To clarify the use of ILS and to encourage its use in psoriasis and localized dermatitis. Medline peer-reviewed literature in English (1956-2008) was searched for the use of ILS in all skin diseases. Six standard textbooks of dermatology were reviewed. Information as to how they used ILS was obtained from a questionnaire completed by 33 dermatologists and from personal discussions with 15 other dermatologists. Additional information was obtained from 40 years of personal ILS use and from observation of 42 dermatologists working intermittently in our office over the past 25 years. ILS product package inserts and company drug monographs were reviewed. ILS is used by most dermatologists, but there are considerable divergences in technique and dosing. Current textbooks contain little on its use in psoriasis and localized dermatitis. There have been no clinical studies since the 1960s, and their end points and descriptions were somewhat vague by today's standards. Product package inserts are dated and not helpful. Nevertheless, the use of ILS is safe and economical, and the original authors and our office have found it consistently to be virtually 100% effective at 2.5 mg/mL in small plaques of psoriasis on the trunk and limbs and highly effective in localized dermatitis (such as lichen simplex chronicus, prurigo nodularis, and nonspecific eczema). Clinical studies indicate that we can safely increase our ILS from the usual 3 cc (7.5 mg) to 6 cc (15 mg) or even to 8 cc (20 mg) for patients over 50 kg every 3 to 4 weeks. Serum cortisol can be performed if there are concerns about adrenal suppression, with use in periorbital hemangiomas and with intranasal ILS. Blindness (from central artery occlusion) was reported with injections of ILS around the eyes wih older products during the early development stages; and more recently with the use of ILS for periorbital hemangiomas and with ILS used intranasally. It has never been reported with low pressure injections of ILS using triamcinalone acetonide at 2.5 mg around the eyes. No formal clinical studies since the 1960s. Poor statistical end points. ILS at 2.5 mg/cc is safe, economical, and effective and its greater use should be encouraged in inflammatory dermatoses such as psoriasis and localized dermatitis. Further well-designed research would be helpful.

Lasertherapie infantiler Hämangiome und anderer kongenitaler vaskulärer Tumore des Säuglings- und Kleinkindalters

As a high rate of spontaneous regression exists for infantile haemangioma, the indication for an active therapy is rare. On the other hand excessive growth can cause permanent defects. Thus, an early differential diagnosis and indication for therapy are necessary. Besides the phase, the localisation and the behaviour are the keys for complications and therefore crucial for the indication. The most important investigation for correct diagnosis as well as for exact determination of the phase and expansion is colour-coded duplex sonography (CCDS). This is an essential prerequisite for an adjusted haemangioma therapy. For the congenital haemangioendothelioma the type and therefore the behaviour determine the indication for therapy. In Kaposiform haemangioendotheliomas, the Kasabach-Merritt phenomenon with disseminated intravasal coagulopathia is the major complication. By means of an early laser therapy these complication can be avoided or reduced. Important is the correct selection of the laser type and laser proce-dure. For superficial strong intracutaneous early stages of infantile haemangioma with less than 3 mm thickness, the flashlamp pumped dye laser (FLPDL) is a good option and superior to cryotherapy because with the FLPDL even larger flat haemangiomas can be treated without epithelial damage. For thicker and primary subcutaneous haemangiomas this laser is not suitable. This is an indication for the cw Nd:YAG-laser applied transcutaneously with ice-cube cooling or mucously in the impression technique. These haemangiomas with a thickness of up to 30 mm are treatable without any epithelial damage. More voluminous or primary deep subcutaneous haemangiomas are interstitially treated with the CCDS-controlled puncture technique. Especially subglottic or tracheal haemangiomas can be treated endoscopically so early that a tracheostomy can be avoided. However, in these haemangiomas and even in periorbital haemangiomas an adjuvant prednisolone therapy is obligatory. Also in Kaposiform haemangioendotheliomas with Kasabach-Merritt phenomenon an adjuvant prednisolone therapy is necessary. The intercurrent laser therapy, preferably transcutaneous Nd:YAG laser with ice-cube cooling, induces the regression and prevents the rebound effect after finishing the prednisolone therapy, so even here a short-term prednisolone therapy is sufficient.