What is the clinical history of infantile hemangiomas?

Updated: Nov 09, 2020
  • Author: Richard J Antaya, MD; Chief Editor: William D James, MD  more...
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Infantile hemangiomas exhibit a characteristic evolution, with early rapid growth (proliferation) followed by slow involution. [1] The earliest sign of a superficial infantile hemangioma is blanching of the involved skin. This may be followed by fine telangiectasias and then a red or crimson macule. Rarely, a shallow ulceration may be the first sign of an incipient infantile hemangioma.

Rapid growth during the neonatal period (birth to 4 wk) is the historical hallmark of infantile hemangiomas. This rate is characteristically beyond the growth rate of the infant, thereby differentiating this neoplasm from vascular malformations that grow commensurate with the infant. As proliferation ensues, the infantile hemangioma becomes elevated and may be dome shaped, lobulated, plaquelike, tumoral, or any combination of these morphologies. [3, 4] The proliferation phase occurs during the first year, with the most growth occurring during the first 4-6 months of life. Proliferation slows considerably between the middle and end of the first year of life; however, most hemangiomas have completed this phase by age 4 months. During this time, the hemangioma may remain quiescent or may begin to involute. [43]

The involutional phase of an infantile hemangioma may be rapid or prolonged. No specific characteristics appear to influence the rate or completeness of involution of infantile hemangiomas. The exception is a separate type of hemangioma referred to as a rapidly involuting congenital hemangioma (RICH), which proliferates in utero and is fully developed at birth. [44] RICHs tend to completely involute during the second year of life. Congenital hemangiomas are not considered to be a variant of the infantile hemangioma.

Fifty percent of infantile hemangiomas complete involution by age 5 years and 70% by age 7 years; the remainder may take an additional 3-5 years to complete the process. [2] Of lesions that have involuted by age 6 years, 38% have residual evidence with scar formation, telangiectasia, or redundant or anetodermic skin. Infantile hemangiomas that take longer to involute have a higher incidence of permanent cutaneous residua. Eighty percent of infantile hemangiomas that complete involution after age 6 years may exhibit cutaneous residua. [45]

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