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Sharma A, Gupta M, Mahajan R. Infantile hemangiomas: a dermatologist's perspective. Eur J Pediatr 2024:10.1007/s00431-024-05655-8. [PMID: 39052139 DOI: 10.1007/s00431-024-05655-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/31/2024] [Accepted: 06/15/2024] [Indexed: 07/27/2024]
Abstract
Infantile hemangioma (IH), the most common vascular tumor in pediatrics, is thought to arise from aberrant stem cell responses to stimuli such as hypoxia. This review explores the diverse manifestations, complications, and management strategies for IH, emphasizing the importance of a multidisciplinary approach. The epidemiology and risk factors associated with IH, including connections to prematurity, low birth weight, and family background, are discussed. The intricate pathogenesis involving hemangioma stem cells, KIAA1429, hypoxia, and the renin-angiotensin system is examined. The natural history and clinical features, as well as extracutaneous involvements such as hepatic IH, PHACES syndrome, and LUMBAR syndrome, are detailed. Complications such as ulceration, functional impairment, hypothyroidism, and cosmetic concerns are highlighted. The differential diagnosis and diagnostic modalities, including colorimeters, high-frequency ultrasonography, and imaging techniques, are discussed. Management approaches, including the use of propranolol, atenolol, corticosteroids, alternative systemic treatments, topical therapy, laser therapy, and surgery, are comprehensively reviewed. The evolving landscape of IH management is underscored, with ongoing research exploring alternative treatments and individualized approaches based on IH characteristics.
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Affiliation(s)
- Apoorva Sharma
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Manavi Gupta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Sun Y, Zhao J, Meng Y, Luo X, Jiang C, Deng G, Lei S. The prevalence, complications, and risk factors for infantile hemangioma: a systematic review and meta-analysis. Int J Dermatol 2024; 63:737-746. [PMID: 38329175 DOI: 10.1111/ijd.17062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
The epidemiological landscape of infantile hemangioma (IH) has been extensively explored through diverse data sources; however, a scarcity of systematically pooled and quantified evidence from comprehensive global studies persists. In this meta-analysis, we systematically review available literature to elucidate the prevalence, distribution of lesions, complications, and risk factors associated with IH. A meticulous search encompassing the Cochrane Library, PubMed, Embase, and Web of Science identified 3206 records, of which 55 studies met the inclusion criteria. We found that the overall prevalence of IH is 2.8% [95% confidence interval (CI): 1.5-4.4%] (31,274,396 infants), and IH was located more frequently in the head and neck with a prevalence of 47.4% (95% CI: 39.5-55.4%). The overall prevalence of complications of IH is 24.3% (95% CI: 18.6-30.5%), ulceration is 16.0% (95% CI: 10.4-21.2%), bleeding is 5.6% (95% CI: 3.3-8.5%), visual impairment is 5.6% (95% CI: 3.0-8.9%), infection is 2.8% (95% CI: 1.5-4.8%), subglottic obstruction is 1.5% (95% CI: 0.5-3.0%), respectively. Through 27 studies, we have evaluated 35 factors encompassing perinatal factors, socioeconomic factors, maternal complications, drug factors, and antepartum procedures, and identified 18 risk factors that increase the prevalence of IH. These findings can greatly assist clinicians and family members in effectively evaluating the risk of IH, and determining whether pregnant women should undergo intensified monitoring or preventive measures.
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Affiliation(s)
- Yuming Sun
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jinhong Zhao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Meng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
- Furong Laboratory, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Xiangyue Luo
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Chufeng Jiang
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Guangtong Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
- Furong Laboratory, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
| | - Shaorong Lei
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, Changsha, China
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Sun Z, Li M, Dong C, Mei S. Clinical characteristics of infantile haemangioma in twins: a retrospective study. BMC Pediatr 2024; 24:111. [PMID: 38350912 PMCID: PMC10863135 DOI: 10.1186/s12887-024-04602-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Infantile hemangioma is one of the most common benign soft tissue tumors in infants. The pathogenesis of infantile hemangioma remains unclear and twin studies regarding its incidence may help clarify disease pathogenesis. Thus, this study aimed to analyze the clinical characteristics of infantile hemangioma in twin patients and discuss its clinical incidence. METHODS We retrospectively analyzed the data of 83 pairs of twins with infantile hemangioma admitted to the Guangdong Provincial Women and Children Hospital and Henan Provincial People's Hospital between May 2016 and May 2022. Thirty-one pairs of twins among whom both developed infantile hemangioma and 52 pairs of twins among whom only one twin was affected were included. Analysis was performed using the Spearman correlation. Additionally, we analyzed the influence of factors such as sex, twin zygosity, preterm birth, birth weight, and assisted reproduction on the clinical characteristics of twins. RESULTS We observed that disease occurrence in both twins correlated with assisted reproduction (χ2 = 13. 102, P < 0.05) and preterm birth (χ2 = 36.523, P < 0.05). Twin zygosity (χ2 = 0.716, P > 0.05) and total birth weight of twins (t=-3.369, P > 0.05) were not correlated with infantile hemangioma. However, among twins, the ones with lesser birth weight were more likely to develop infantile hemangioma. CONCLUSIONS The clinical characteristics of infantile hemangioma in twins were consistent with their epidemiological characteristics. Female sex, preterm birth, less birth weight, and assisted reproduction increased the probability of morbidity in both twins. Analysis of the characteristics of infantile hemangioma in twins may assist further research and clinical treatment.
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Affiliation(s)
- Zhengwei Sun
- Department of Interventional Radiology and Hemangioma, Guangdong Province Woman and Children Hospital, Guangzhou, People's Republic of China
| | - Miaomiao Li
- Department of Hemangioma and Vascular Malformation, Henan Provincial People's Hospital, Zhengzhou, People's Republic of China.
| | - Changxian Dong
- Department of Hemangioma and Vascular Malformation, Henan Provincial People's Hospital, Zhengzhou, People's Republic of China
| | - Shiwei Mei
- Department of Interventional Radiology and Hemangioma, Guangdong Province Woman and Children Hospital, Guangzhou, People's Republic of China
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Sandru F, Turenschi A, Constantin AT, Dinulescu A, Radu AM, Rosca I. Infantile Hemangioma: A Cross-Sectional Observational Study. Life (Basel) 2023; 13:1868. [PMID: 37763272 PMCID: PMC10532986 DOI: 10.3390/life13091868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/31/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: With an incidence of 4-10%, infantile hemangiomas (IH) are the most encountered benign tumors in infancy. Low birth weight (LBW), prematurity, female sex, multiple gestations, and family history of IH are some of the statistically proven risk factors for developing IH. The aim of our study was to evaluate the prevalence of IH in our clinic and its connection to maternal and perinatal factors. (2) Methods: We conducted a cross-sectional study, over three years (2020-2022), at the Clinical Hospital of Obstetrics and Gynecology, "Prof. Dr. P. Sârbu", in Bucharest, Romania. (3) Results: During this period, 12,206 newborns were born and we identified 14 infants with infantile hemangioma. In our study, the prevalence of infantile hemangioma was 0.11%. The prevalence of IH in pregnancies obtained through in vitro fertilization was 1%, in twin pregnancies it was 2.27%, and in those with placenta previa, it was 4.16%. (4) Conclusions: Our findings provide a solid image of the prevalence of IH in our country and underline that the development of IH is strongly connected to maternal and perinatal variables, such as: preterm newborns, in vitro fertilization, high blood pressure, anemia, hypothyroidism, placenta previa, and twin pregnancy.
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Affiliation(s)
- Florica Sandru
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania;
- Department of Dermatovenerology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | | | - Andreea Teodora Constantin
- Pediatrics Department, National Institute for Mother and Child Health “Alessandrescu-Rusescu”, 20382 Bucharest, Romania;
- Department of Pediatrics, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania
| | - Alexandru Dinulescu
- Department of Pediatrics, Grigore Alexandrescu Emergency Hospital for Children, 011743 Bucharest, Romania;
| | - Andreea-Maria Radu
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ioana Rosca
- Department of Neonatology, University of Medicine and Pharmacy “Carol Davila”, 020021 Bucharest, Romania;
- Neonatology Department, Clinical Hospital of Obstetrics and Gynecology “Prof. Dr. P. Sârbu”, 060251 Bucharest, Romania
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Maternal and Perinatal Risk Factors for Infantile Hemangioma: A Matched Case-Control Study with a Large Sample Size. Dermatol Ther (Heidelb) 2022; 12:1659-1670. [PMID: 35751738 PMCID: PMC9276869 DOI: 10.1007/s13555-022-00756-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/06/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Infantile hemangioma (IH) is the most common benign tumor in infancy, but information about its pathogenesis is limited. The aim of this study was to determine maternal and perinatal risk factors for IH. Methods A total of 1033 IH patients were enrolled in the study between 2017 and 2020. IH patients were matched with controls by sex. Trained investigators collected detailed information from the participants. Logistic regression models were used for multivariate analysis. Results The statistical analysis demonstrated that miscarriage history (odds ratio [OR] = 4.275; 95% confidence interval [CI] [3.195, 5.720]), anemia in pregnancy (OR = 4.228; 95% CI [3.083, 5.799]), preterm premature rupture of membranes (PPROM) (OR = 3.182; 95% CI [1.359, 7.454]), placenta previa (OR = 2.440; 95% CI [1.787, 3.333]), threatened miscarriage (OR = 2.290; 95% CI [1.726, 3.039]), premature rupture of membranes (PROM) (OR = 1.785; P < 0.05), progesterone use (OR = 1.614; P < 0.001) and abnormal amniotic fluid volume (OR = 1.499; P < 0.05) were independent risk factors for IH. Gestational diabetes mellitus (GDM) (OR = 0.607; 95% CI [0.464, 0.794]), multiple gestations (OR = 0.407; 95% CI [0.232, 0.713]), hypothyroidism (OR = 0.407; 95% CI [0.227, 0.730]) and uterine fibroids (OR = 0.393; 95% CI [0.250, 0.618]) may reduce the risk of IH. Conclusions Maternal and perinatal factors are closely associated with IH occurrence. Our study provides reliable clues to guide further exploration of the pathogenesis of IH. Trial Registration ClinicalTrials.gov, NCT03331744. Plain Language Summary Infantile hemangioma is the most common benign tumor in children, which seriously affects appearance and function and even threatens life. The pathogenesis is not clear, a detailed case-control study of the maternal and perinatal periods with a large sample size will facilitate the development of individualized and precise treatment, early and timely interventions for high-risk children and improvement of prognosis. Our study found that miscarriage history, anemia in pregnancy, preterm premature rupture of membranes (PPROM), placenta previa, threatened miscarriage, premature rupture of membranes (PROM), progesterone use and abnormal amniotic fluid volume were independent risk factors for IH. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00756-4.
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Lin PF, Chen FC, Chen JY, Hu LH, Xie WJ, Liu TY, Guo SB, Lin XM, Liu XW, Ye XH, Li M, Jiang CH. Incidence and familial clustering of infantile hemangiomas: A multicenter study. J Eur Acad Dermatol Venereol 2022; 36:1641-1647. [PMID: 35470460 DOI: 10.1111/jdv.18179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The exact incidence of infantile hemangiomas (IH) in the Chinese population is still unknown. A positive family history of IH was considered as a risk factor for the development of IH. OBJECTIVES This study aims to investigate the incidence of IH in the Chinese population and the mechanism of family history increases the risk for IH development. METHODS 2489 women and their newborns were enrolled in the prospective study. All newborns were followed up for 12 months to determine whether they developed IH. In addition, 213 IH probands and their 174 siblings were enrolled in the study. The incidence of IH in siblings of the IH probands was investigated. Information regarding risk factors for IH and demographic data were collected on all children. RESULTS Of the 2572 newborns, 58 IH were identified in 56 (2.2%) newborns. The majority of IH were located on the trunk (46.6%). Siblings of the IH probands were at increased risk for the development of IH (P = 0.024, relative risk 2.451), and the occurrence of prenatal risk factors for IH(P = 0.003) compared with the general population. CONCLUSIONS Our study showed that the incidence of IH is 2.2% in the Chinese population. Siblings of the individuals with IH were at increased risk for the development of IH may be related to the family clustering of prenatal risk factors for IH. Further exploration of the mechanisms and common features of these prenatal risk factors may help to disclosure the origin and pathogenesis of IH.
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Affiliation(s)
- Peng-Fei Lin
- Department of Plastic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.,Department of Plastic Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, China
| | - Fa-Chun Chen
- Department of Plastic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Jia-Yao Chen
- Department of Plastic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.,Department of Plastic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 51000, China
| | - Li-Han Hu
- Department of Plastic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Wen-Jun Xie
- Department of Plastic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Ting-Yuan Liu
- Department of Plastic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Sheng-Bin Guo
- Department of Obstetrics, Fujian, Maternal and Child Health Hospital, Fuzhou, 350001, China
| | - Xue-Mei Lin
- Department of Obstetrics, Fuzhou Fuxing Maternity Hospital, Fuzhou, 350001, China
| | - Xiu-Wu Liu
- Department of Obstetrics, Fujian, Maternal and Child Health Hospital, Fuzhou, 350001, China
| | - Xian-Hua Ye
- Department of Clinical Laboratory, Fuzhou Fuxing Maternity Hospital, Fuzhou, 350001, China
| | - Ming Li
- Department of Plastic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.,Department of Plastic Surgery and Regenerative Medicine Institute, Fujian Medical University, Fuzhou, 350001, China.,Tissue and Organ Regeneration Engineering Center of Fujian Higher Education, Fuzhou, 350001, China
| | - Cheng-Hong Jiang
- Department of Plastic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.,Department of Plastic Surgery and Regenerative Medicine Institute, Fujian Medical University, Fuzhou, 350001, China.,Tissue and Organ Regeneration Engineering Center of Fujian Higher Education, Fuzhou, 350001, China
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Gong X, Li Y, Yang K, Chen S, Ji Y. Infantile hepatic hemangiomas: looking backwards and forwards. PRECISION CLINICAL MEDICINE 2022; 5:pbac006. [PMID: 35692445 PMCID: PMC8982613 DOI: 10.1093/pcmedi/pbac006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
Infantile hepatic hemangiomas (IHHs) are common benign tumors seen in the liver of infants. IHHs are true infantile hemangiomas (IHs) and have phases of proliferation and involution parallel to those of cutaneous IHs. The definition and classification of IHH are still confusing in the literature. The mechanisms during the pathogenesis of IHH have yet to be discovered. The clinical manifestations of IHH are heterogeneous. Although most IHH lesions are asymptomatic, some lesions can lead to severe complications, such as hypothyroidism, consumptive coagulopathy, and high-output congestive cardiac failure. Consequently, some patients can possibly encounter a fatal clinical condition. The heterogeneity of the lesions and the occurrence of disease-related comorbidities can make the treatment of IHH challenging. Oral propranolol is emerging as an effective systemic approach to IHH with obvious responses in tumor remission and symptom regression. However, the precise clinical characteristics and treatment strategies for patients with severe IHH have not yet been well established. Here, we summarize the epidemiology, pathogenic mechanism, clinical manifestations, diagnosis, and treatment of IHH. Recent updates and future perspectives for IHH will also be elaborated.
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Affiliation(s)
- Xue Gong
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yanan Li
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Kaiying Yang
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Siyuan Chen
- Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yi Ji
- Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China
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