How are infantile hemangiomas with minimal or arrested growth (IH-MAG) characterized?

Updated: Nov 09, 2020
  • Author: Richard J Antaya, MD; Chief Editor: William D James, MD  more...
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Another variant is the infantile hemangioma with minimal or arrested growth (IH-MAG). These have been previously referred to as abortive, reticular, or telangiectatic infantile hemangiomas. By definition these IHs have a proliferative component equaling less than 25% of their total surface area. They are mostly flat and may simply present with an erythematous blush of the affected skin.

As its prior name suggests, an abortive or reticular infantile hemangioma often has telangiectasia coursing through it. This variant may be confused with a capillary malformation; however, the growth characteristics and presence of visible telangiectases assist in differentiation. This variant has been seen in association with underlying vascular and other extracutaneous congenital anomalies (PHACE and PELVIS syndromes and with underlying vascular anomalies on an extremity) as well as demonstrating a predilection for the lower body, in contradistinction to classic IHs. [46, 47]

During involution, which may begin as early as a few months from birth or as late as 2-3 years, the infantile hemangioma resolves centrifugally from the center of the lesion. This is less notable with deeper lesions. The superficial lesions become less red, taking on a duskier maroon-to-purple color, and finally regaining normal flesh tones (often referred to as "graying"). With involution, the infantile hemangiomas become softer and more compressible with decreased tenderness, and they exhibit less expansion during increased intravascular pressure (eg, crying).

During the late involution phase (quiescent residual lesions), the skin may return to normal with no evidence of a previous pathologic process. Approximately 50-60% of all hemangiomas resolve incompletely, leaving permanent changes in the skin. These changes include telangiectases, superficial dilated veins, stippled scarring, anetoderma or epidermal atrophy (particularly with superficial lesions), hypopigmentation, and/or redundant skin with fibrofatty residua (especially with subcutaneous lesions). [45]

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