Treatment Of Cutaneous Hemangiomas Research Articles

Clinical Profile of Paediatric Hemangiomas, Response to Oral Propranolol, and Comparison of Intralesional Bleomycin and Triamcinolone in Propranolol Non Responders at a Tertiary Care Center in North India.

Background:A paradigm shift has occurred regarding the treatment of cutaneous hemangiomas over the last few years, from an open surgical approach to a conservative or minimally invasive approach. There are various treatment modalities described, and response to them is variable and unpredictable. This study was conducted to study the clinical profile of children with uncomplicated cutaneous hemangiomas, their response to oral propranolol, and compare intralesional bleomycin and intralesional triamcinolone among nonresponders to propranolol.Materials and Methods:A trial was conducted among 158 children <12 years with cutaneous hemangiomas from January 2019 to October 2020 in Kanpur, Uttar Pradesh. Based on the response to propranolol, partial/nonresponders were later assigned randomly to either receive intralesional bleomycin (n = 30) or intralesional triamcinolone (n = 29). Response to treatment and complications were assessed in two groups. All children were followed up for 6 months.Results:Of 158 children, complete response to propranolol was found in 99 (62.7% [95% confidence interval (CI): 54.6%–70.1%]) children. Partial and no response was found in 33 (20.9% [95% CI: 15.0%–28.2%]) and 26 (95% CI: 16.5% [11.2%–23.4%]) children, respectively. In the bleomycin group, 66.7%, 23.3%, and 10.0% of patients showed excellent, good, and poor response, respectively, and in the triamcinolone group, 27.6%, 24.1%, and 48.3% showed excellent, good, and poor response, respectively (P = 0.002). However, there was no significant difference between them in terms of complications.Conclusion:Intralesional bleomycin was found to be a better drug in terms of response compared to triamcinolone. There are no significant differences in complications between them. Further studies are needed to further evaluate the combined efficacy of bleomycin with triamcinolone and other treatment modalities.

P157: Treatment of Cutaneous Hemangiomas with Topical Imiquimod 5%

P157: Treatment of Cutaneous Hemangiomas with Topical Imiquimod 5%

Otolaryngologic manifestations of PHACE syndrome

Two case reports of PHACE syndrome (posterior fossa malformations (P), hemangiomas (H), arterial anomalies (A), coarctation of the aorta and cardiac defects (C), and eye abnormalities (E)) are presented. Clinical characteristics consisted of cutaneous and airway hemangiomas, aortic coarctation, and left superior vena cava in one child and cutaneous and airway hemangiomas, sternal clefting, and supraumbilical raphe in the other child. Treatment modalities included systemic and intralesional steroids for cutaneous and airway hemangiomas, submucosal resection and laryngotracheal reconstruction for airway hemangiomas, repair of aortic coarctation, and laser treatment of cutaneous hemangiomas. PHACE syndrome poses a significant potential for airway compromise from hemangiomas, which may require multimodality treatment.

Treatment of cutaneous hemangiomas in preterm neonatal twins with the flashlamp-pumped pulsed dye laser

We report two cases of hemangiomas in twins born at a gestational age of 30 weeks who were treated with a flashlamp-pumped pulsed dye laser (FPDL) at 40 days postpartem. These were the youngest patients to our knowledge to be treated with FPDL.Twin Caucasian females were born 10 weeks preterm. Twin A soon developed a 1 cm blanching erythematous patch with telangiectasia on a slightly bulbous nasal tip. Twin B developed a 6 mm erythematous papule on her forehead, a 12 x 10 cm erythematous plaque on her left shoulder, and two plaques measuring 2.5 x 2.0 cm and 1.5 x 1.0 cm on her right hip. The twins received seven monthly laser treatments.Several of the hemangiomas showed remarkable regression, including the lesions which became ulcerated and healed on Twin B's left shoulder and right hip. No general or topical anesthesia was used and the twins tolerated the procedure well. No significant adverse effects were encountered. The maximum single treatment dose was 7 mm spot size, 5.0 J/cm2 and 186 pulses for twin B and 6.25 J/cm2 and 16 pulses for twin A.To our knowledge, our patients are the youngest reported to be treated with FPDL at age 30 days preterm. Some of their hemangiomas responded, and no significant adverse effects were encountered. More prospective trials are needed to determine whether early treatment with FPDL accelerates regression of hemangiomas or results in a better cosmetic outcome than expectant treatment.

Treatment of cutaneous hemangiomas in preterm neonatal twins with the flashlamp‐pumped pulsed dye laser

Treatment of cutaneous hemangiomas in preterm neonatal twins with the flashlamp‐pumped pulsed dye laser

Multimodal management of diffuse neonatal hemangiomatosis

Diffuse neonatal hemangiomatosis is a rare, frequently fatal disorder. We describe the case of a neonate with numerous cutaneous and ocular hemangiomas. Hepatic hemangiomas were noted at 4 weeks of age, associated with congestive heart failure resulting from hepatic arteriovenous shunting. This condition was controlled by treatment with prednisone, interferon alfa-2b and hepatic embolization. Treatment of cutaneous hemangiomas with the tunable dye laser prevented hemorrhage, facilitated routine skin care, and allowed uninhibited intravenous access during hospitalization.

Treatment of cutaneous hemangiomas by the flashlamp-pumped pulsed dye laser: Prospective analysis

Thirty-three cutaneous capillary and mixed hemangiomas in 24 patients were treated prospectively with the flashlamp-pumped pulsed dye laser. Patients ranged in age from 2 weeks to 7 months; the follow-up period was up to 22 months. Some patients received therapy until the lesion was almost clear or until the lesion failed to respond; others received treatment only until active capillary lesional proliferation abated. In the first group of patients, 18 of 25 lesions that were 3 mm or less in elevation lightened with therapy (93.9% +/- 4.6% in 4.1 +/- 1.6 treatment sessions) and flattened to 0.3 +/- 0.4 mm in thickness. The seven lesions that were 4 mm or more in thickness lightened 85.7% +/- 7.3% in 7.0 +/- 2.0 treatment sessions but showed less diminution in thickness (to 3.4 +/- 3.6 mm; p less than 0.01). The second group of patients, who received therapy until proliferation ceased, required just one to three therapeutic sessions. Three of the four lesions that showed residual atrophy were 4 mm or greater in thickness; the fourth lesion was ulcerated on presentation. None of the lesions had residual induration or scarring. We conclude that the flashlamp-pumped pulsed dye laser may successfully prevent enlargement and promote involution of capillary hemangiomas with minimal adverse effects. Therapy is most appropriate for patients with hemangiomas at sites of potential functional impairment, of maceration or ulceration, and of significant cosmetic disfigurement. Therapy should be initiated as early as possible, when lesions are relatively flat, for optimal results.

Treatment of cutaneous and deep vascular lesions with the Nd

This study intends to document and evaluate the first compiled experience in the treatment of both cutaneous and deep vascular lesions using the Nd:YAG laser. Thirty-eight patients were treated over a 5-year period from 1979 to 1984 using the Nd:YAG laser with FDA approval. Lesions included capillary, cavernous, combined capillary-cavernous hemangiomas, portwine stains, arteriovenous malformations, lymphangiomas, multiple telangectasias, and one case of Klippel-Trenaunay-Webber syndrome. The number of treatments per patient ranged from one to four. Partial or complete resolution of these various lesions, as evidenced by a decrease in size, and/or normalization of pathologic cutaneous changes was noted in a majority of patients. While both the argon and CO2 lasers have been well studied in the treatment of cutaneous vascular lesions, this is the first compiled series reporting results using the Nd:YAG for such problems. The Nd:YAG laser represents an alternative modality in the treatment of cutaneous hemangiomas and introduces an efficacious method in the treatment of cavernous vascular lesions.

Corticosteroid therapy in the treatment of cutaneous hemangioma of infancy and childhood.

Steroid therapy, in form of systemic, intralesional injection and local application was tried in thirty four cases of cutaneous hemangioma presenting with rapidly increasing lesion, affecting function of the eye and the nose, infection, hamorrhage and platelet sequesteration. The response to the intralesion and the surface steroid therapy was minimal. The oral steroid therapy in short courses was most beneficial in the infancy and in the management of big ulcerated and infected cutaneous hemangiomas.