A review of 58 patients with periorbital haemangiomas to determine appropriate cases for intervention

Comparison of intralesional corticosteroid and propranolol treatment of periorbital infantile hemangiomas: an outcome study of 61 cases

PURPOSE

To compare intralesional corticosteroid (IC) injections with oral propranolol in children with periorbital infantile hemangioma (IH).

METHODS

Children were diagnosed with IH and treated with IC (n = 29) or propranolol (n = 14). In cases in which no further improvement was seen, treatment was stopped and the outcome measured. Type, duration, and complications of treatment and supportive or additional therapies were scored, along with outcomes of visual measurements, at the start and end of therapy.

RESULTS

Twenty-one of the 29 children (72%) treated with IC injections were given a second injection and 16 (55%) were given more than two. Median duration of IC therapy was 15.9 months (interquartile range (IQR) 10.28), compared with 6.5 months (IQR 4.87) for propranolol (p<0.001). The complications reported after IC injections were bleeding (n = 9) and ulceration (n = 7). No complications were noted in the propranolol group. Additional therapy consisting of oral prednisolone therapy was applied in one child from the steroid-treated group. The levels of amblyopia and the median absolute improvement did not significantly differ between the groups.

CONCLUSIONS

The IC injections and oral propranolol medication equally improved amblyopia in children with IH of the periorbital and cheek region; however, propranolol was associated with fewer complications and additional or supportive treatment was not indicated. We prefer oral propranolol medication over IC injections in cases in which IH threatens to hamper visual acuity.

Haemangioma: clinical course, complications and management

Despite their high incidence, most infantile haemangiomas (IH) do not require treatment as they regress spontaneously and most do not leave significant sequelae. For the subset of haemangiomas that require treatment, indications for intervention can be divided into three main categories: ulceration, disfigurement and impairment of function or vital structures. In addition, certain IH have a risk of associated structural anomalies. Given the wide heterogeneity of haemangiomas, deciding which haemangiomas need intervention and when to intervene requires a detailed knowledge of natural history and clinical indicators of increased risk.

Successful discontinuation of propranolol for infantile hemangiomas of the head and neck at 12 months of age

BACKGROUND

Although propranolol can be an effective primary medical therapy for infantile hemangiomas of the head and neck, the duration of treatment and time to discontinue propranolol is unclear.

OBJECTIVE

The objective of this study is to determine the duration of treatment and age at which propranolol may be successfully discontinued in children with infantile hemangiomas of the head and neck.

METHODS

A review of all patients presenting to a pediatric vascular anomalies clinic from January 2008 to December 2011 was performed. Those with head and neck infantile hemangiomas who completed propranolol therapy were included. Each patient's records were reviewed for demographics, clinical response to propranolol, age at discontinuation of propranolol, and adverse events.

RESULTS

Forty-five patients were included for review (mean age at presentation, 3.5 months) with all demonstrating positive responses. The mean age at discontinuation of propranolol was 11.8 months of age (range, 8-15 months) with a mean treatment duration of 6.5 months (range, 3-11 months). No recurrences were noted over a mean follow-up period of 19.9 months (range, 10-28 months).

CONCLUSION

Discontinuation of propranolol at approximately 12 months of age was found to be appropriate in our study population.

Scoring the proliferative activity of haemangioma of infancy: the Haemangioma Activity Score (HAS)

BACKGROUND

Haemangioma of infancy (HOI) is the most frequently occurring benign tumour of infancy. A good, reliable and objective scoring system for haemangioma activity is not yet available.

AIM

We have developed a simple system called the Haemangioma Activity Score (HAS) for scoring the (disease) proliferative activity of haemangiomas. The current study was undertaken to validate this system.

METHODS

We validated the HAS in a comparative study of photographs taken during consultations from 2000 until 2008 (n = 78). Agreement between three observers was assessed at two different time points (t(0) and t(1)) with a minimum interval of 6 months between them, using interclass correlation coefficients (ICC).

RESULTS

Agreement between observers was good. The average ICC of the HAS at t(0) and t(1) was 0.72 and 0.76, respectively. The average ICC of the HAS for the changes from baseline (HAS at t(0) minus HAS at t(1) ) was 0.69.

CONCLUSIONS

We conclude that the HAS is a good system for scoring the proliferative activity of haemangiomas, and believe it to be useful in future investigations. The number of studies comparing different therapies for treating haemangiomas is steadily increasing, and the HAS (before and after treatment) may provide a valuable scoring system for evaluating such therapies.