Hemangioma Update: Pearls From 30 Years of Treatment

Timing and Efficacy Evaluation of 755-nm Long Pulse Alexandrite Laser and 2% Carteolol Hydrochloride Eye Drops Co-Treatment for Thicker Superficial Infantile Hemangioma

Purpose

Superficial Infantile hemangioma (SIH) is the most common type of IH. Some studies have shown the efficacy of 755-nm long pulse alexandrite laser (LPAL) and topical 2% carteolol hydrochloride (C-HCL) eye drops for the treatment of SIH. This article retrospectively analyzes the safety and efficacy of 755-nm LPAL combined with 2% C-HCL eye drops for treating thicker SIH, and explores the optimal treatment time for SIH.

Materials and Methods

This study included 2-5 mm thick SIH patients who received co-treatment of 755-nm LPAL and 2% C-HCL eye drops. The SIH patients were divided into 3 groups based on their age and IH growth curve: ≤ 1 month (≤ 1M), 1-3 months (excluding 1 month; 1-3M), and 3-12 months (excluding 3 months; 3-12M).

Results

There was no difference in efficacy between the ≤ 1M and the 1-3M group, and were both better than the 3-12M group. Furthermore, there was no difference in the average number of treatments between the ≤ 1M and 1-3M groups and were both less than the 3-12M group. There was no significant difference in the incidence of adverse reactions between the groups. Compared with the ≤ 1M and 1-3M groups, the 3-12M group indicated more permanent skin lesions after the treatment.

Conclusion

It was revealed that co-treatment with 755-nm LPAL and 2% C-HCL eye drops is safe and effective against thicker SIH. Compared with the 3-12M group, ≤ 3 months can achieve better efficacy, requires a shorter treatment time, less likely to leave permanent skin lesions such as scars. Moreover, patients with no proliferation can be observed to 1 month.

Timing and Efficacy of 595-nm Pulsed-Dye Laser Combined with 0.5% Timolol Maleate Solution in the Treatment of Superficial Infantile Hemangiomas

Purpose

Infantile hemangioma (IH) is the most common benign tumor in infancy, and superficial IH is the most common type. IH can reportedly resolve spontaneously, but this is associated with complications, such as scars, atrophy, hypopigmentation, telangiectasia, and skin sagging, in 70% of cases. This study explores the safety and feasibility of therapeutic intervention with the 595-nm pulsed-dye laser (PDL) combined with 0.5% timolol maleate solution in superficial IH and compares the difference in efficacy between the early group and the late group.

Patients and Methods

This retrospective study examined 167 patients with superficial IH who underwent combination therapy at the Dermatology Clinic of the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University between July 2019 and July 2020. The early and late groups were composed of children aged ≤2 and >2 months, respectively. Treatment was administered for 6 months, and patients were followed up for another 6 months. Two independent, double-blinded physicians reviewed photographs of the skin lesions before and after treatment to evaluate efficacy.

Results

The early group demonstrated higher treatment efficacy than the late group. The early (n = 45) and late (n = 122) groups had treatment efficacy rates of 95.5% and 86.1%, respectively; the difference was statistically significant (P< 0.05). The early and late groups underwent 3.51 ± 0.50 and 4.73 ± 0.68 months of treatment, respectively; the difference was statistically significant (P< 0.05). Seventeen (44.4%) patients in the early group had immediate adverse reactions but no permanent sequelae, whereas 25 (20.49%) and 13 (10.7%) patients in the late group had immediate and permanent sequelae, respectively. The difference was statistically significant (P<0.05).

Conclusion

This retrospective study demonstrated that 595-nm PDL combined with 0.5% timolol maleate solution was a safe and effective local treatment for superficial IH. Early treatment required fewer treatments, had better curative effects, and a lower probability of permanent sequelae.

Sequelae After Involution of Superficial Infantile Hemangioma: Early Intervention with 595-nm Pulsed Laser Combined with 755-nm Long-Pulsed Alexandrite Laser versus Wait-and-See

Background and Objective

Infantile haemangioma (IH) is the most common benign tumor in children. At present, pulsed dye laser (PDL) has made great progress in the treatment of superficial IH, showing good safety and effectiveness. But some doctors think that superficial IH should choose to wait-and-see. However, studies have reported that most of the IH after resolution still has residual disease, and thickness seems to be an important factor. Therefore, the purpose of this study is to investigate the relationship between Sequelae and thickness after superficial IH involution. In addition, compare the Sequelae difference between 595-nm pulsed laser combined with 755-nm long-pulse alexandrite laser treatment and wait-and-see.

Materials and Methods

This retrospective observational study included patients with superficial IH evaluated in the past 6 years and divided them into a laser group and an observation group.

Results

The incidence of sequelae in the laser group was 44.6%, and the incidence of sequelae in the observation group was 69.5%. The incidence of Sequelae of superficial IH in the laser group was significantly lower than that in the observation group (χ ²-test, χ ²=10.790, P <0.001). In the observation group, the average A scores of the three thickness subgroups (<2mm, 2-5mm, and >5mm) were 4.38, 3.39, and 1.80, and there were significant differences in the A scores between the three groups (Kruskal-Wallis, p<0.05). There is a significant difference in the A score between the laser group and the observation group in the superficial IH with a thickness of 2-5 mm and>5mm (Wilcoxon rank sum test, P<0.05).

Conclusion

This retrospective study showed that the degree of Sequelae of superficial IH after involution is related to its thickness. In addition, the early intervention of 595-nm pulsed laser combined with 755-nm long-pulse alexandrite laser can reduce the incidence and extent of sequelae.

Prospective Comparison of Dual Wavelength Long-Pulsed 755-nm Alexandrite/1,064-nm Neodymium:Yttrium-Aluminum-Garnet Laser versus 585-nm Pulsed Dye Laser Treatment for Rosacea

BACKGROUND

Rosacea treatments including oral/topical medications and laser therapy are numerous but unsatisfactory.

OBJECTIVE

To compare the effectiveness of the dual wavelength long-pulsed 755-nm alexandrite/1,064-nm neodymium: yttrium-aluminum-garnet laser (LPAN) with that of 585-nm pulsed dye laser (PDL) for rosacea.

METHODS

This was a randomized, single-blinded, comparative study. Full face received four consecutive monthly treatments with LPAN or PDL, followed-up for 6 months after the last treatment. Erythema index was measured by spectrophotometer, and digital photographs were evaluated by consultant dermatologists for physician's global assessment. Subjective satisfaction surveys and adverse effects were recorded.

RESULTS

Forty-nine subjects with rosacea enrolled and 12 dropped out. There were no significant differences between LPAN and PDL in the mean reduction of the erythema index (p=0.812; 3.6% vs. 2.8%), improvement of physician's global assessment (p=1.000; 88.9% vs. 89.5%), and subject-rated treatment satisfaction (p=0.842; 77.8% vs. 84.2%). PDL showed more adverse effects including vesicles than LPAN (p=0.046; 26.3% vs. 0.0%). No other serious or permanent adverse events were observed in both treatments.

CONCLUSION

Both LPAN and PDL may be effective and safe treatments for rosacea.

Misdiagnosis of pathological femoral fracture in a patient with intramuscular hemangioma: A case report

Hemangioma is a common disease; however, intramuscular hemangioma (IH) presenting with a pathological fracture is extremely rare. The present study reports a case of a 46-year-old male patient that suffered from IH of the right thigh, presenting with a pathological femoral fracture. The patient was initially diagnosed with a traumatic femoral fracture, and routine open reduction and internal fixation were performed at a local hospital. However, 20 days subsequent to surgery, gradual swelling and soreness around the incision were observed. The incision eventually ruptured during squatting for bowel movement, which led to extensive blood loss. Based on computed tomography (CT) and deep femoral artery arteriography, IH presenting with a pathological femoral fracture was diagnosed. The patient underwent artery embolization, from which he recovered well. At the 6-month follow-up, the femoral fracture was revealed to have healed, and a CT scan demonstrated no evidence of recurrence; however, continuous observation using CT is required in order to determine the long-term outcome. To the best of our knowledge, this is the first case of a misdiagnosed pathological femoral fracture in a patient with IH reported in the English literature.

Shouldn't Propranolol Be Used to Treat All Haemangiomas?

INTRODUCTION

Infantile haemangioma is the most common childhood tumour. These tumours can cause significant functional and cosmetic problems. While there are many treatment modalities, propranolol is increasingly being recognised as the first-line treatment of problematic haemangiomas. This study investigates the use of oral propranolol for the treatment of all haemangiomas at a tertiary children's hospital.

METHOD

This is a retrospective study evaluating 15 children (3 boys and 12 girls) presenting at a tertiary children's hospital with infantile haemangioma during a 24-month period. The protocol consisted of pre-treatment ultrasonic evaluation of the lesion, followed by the commencement of propranolol therapy (2 mg/kg orally in two divided doses), with repeat imaging performed at 16-24 weeks in order to document the dimensional changes. Adverse effects of propranolol were documented. Intralesional bleomycin was utilised as a second-line modality of treatment for large or problematic haemangiomas with inadequate regression in size after oral propranolol therapy.

RESULT

Fifteen (15) patients with a mean age of 7 months (Range: 3-14 months) presented with haemangiomas. Ten patients presented with lesions affecting the head and neck region (67%). Three patients presented with an ulcerated haemangioma, which responded to propranolol and simple dressings and all healed completely. The average decrease in size between the ultrasonography procedures was 48.87%. Only one patient showed no improvement. No side effects were reported. Concomitant bleomycin treatment was reserved for large problematic haemangiomas and proved successful at speeding up the involution process.

CONCLUSION

This study suggests that propranolol become the first-line treatment of choice for all haemangiomas. It has proven to be effective and safe for reducing the size of all haemangiomas during the proliferative phase.

LEVEL OF EVIDENCE IV

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Infantile Hemangioma: Clinical Characteristics and Efficacy of Treatment with the Long-Pulsed 1,064-nm Neodymium-Doped Yttrium Aluminum Garnet Laser in 794 Chinese Patients

OBJECTIVE

This study aimed to evaluate the clinical characteristics of infantile hemangiomas (IHs) and the safety and efficacy of the long-pulse 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for definitive treatment of IHs in 794 Chinese patients.

METHODS

Infants with hemangiomas who had received long-pulse 1,064-nm Nd:YAG laser treatment in our department in the last 5 years were recruited. Demographic and clinical characteristics were recorded and outcomes of long-pulse 1,064-nm Nd:YAG laser treatment were assessed. Statistical analyses were performed to identify factors that affected the efficacy of treatment.

RESULTS

The efficacy of long-pulse 1,064-nm Nd:YAG laser for the treatment of IHs in all patients in our study was 87.57%. Efficacy did not depend on sex or the location of the lesion. Older age and superficial hemangioma were the primary factors contributing to greater efficacy of long-pulse 1,064-nm Nd:YAG laser treatment for IHs. The most common side effects were pigment changes, skin atrophy, and wrinkled redundant skin, which usually resolved spontaneously within 1 to 3 years.

CONCLUSIONS

Long-pulse 1,064-nm Nd:YAG laser is a safe and efficacious treatment for IHs.

Beneficial effects of early treatment of infantile hemangiomas with a long-pulse Alexandrite laser

BACKGROUND AND OBJECTIVE

There is an increasing interest in treating vascular lesions with a long-pulse Alexandrite laser. However, it is difficult to search information in the literature about infantile hemangiomas (IH) treated with long-pulse Alexandrite laser. This article aims to determine whether 755 nm long-pulse Alexandrite laser is effective and safe for early intervention of IH and provides some new data on this issue.

MATERIALS AND METHODS

This is a retrospective study of 48 infants with IH treated with long-pulse Alexandrite laser during a 1.5-year period. Patients received a series of 1-7 treatment sessions with long-pulse Alexandrite laser at settings of 3 milliseconds pulse duration, 6-8 mm spot, 45-70 J/cm(2) fluences, and with dynamic cooling device (DCD) spray duration of 90 milliseconds and delay of 80 milliseconds, given at 4- to 6-week intervals.

RESULTS

This study demonstrated that IH responded favorably to the treatment of a long-pulse Alexandrite laser while accompany with relatively few complications. The difference between the original untreated and post-treatment scores of all IH and two subgroups were statistically significant, respectively (P < 0.01). The difference of the degree of improvement between the two subgroups was not significant (P > 0.05). It was observed that IH on the trunk and extremities improved more effectively and more quickly than those on the face, neck, and perineum. Besides, age at the first treatment, the sex of the patients and the presence of proliferation were not significantly correlated with the degree of improvement. Adverse effects were seen in 11 patients (22.91%): blistering (n = 9), marked edema and erosion without subsequent residual scarring (n = 1), and hypopigmentation (n = 1), which improved gradually with time. Fortunately, there was no incidence of scarring or ulceration in this case series of IH.

CONCLUSIONS

It was clinically effective and safe for early treatment of IH, including the thick/deep ones, with a long-pulse Alexandrite laser, which indicated be able to reduce the possibility that the IH will reach its full size. In this way it can prevent several complications connected to the rapid proliferation of IH.