Infantile hemangiomas: A review

Abstract

Infantile hemangiomas (IH) are the most common eyelid and orbital tumors of childhood. Although they are considered benign lesions that have a generally self-limited course, in the periocular region, they have the potential to cause amblyopia, strabismus, and severe disfigurement. The decision for treatment can be a source of anxiety for patients, parents, and physicians alike. There are numerous treatment modalities, including emerging therapies that may make treatment safer and more effective than ever before. This review discusses our current understanding of this disease, its management, and future therapies.

Keywords: Capillary hemangioma; Infantile hemangioma; Propranolol treatment.

Figure 1

Examples of different types of infantile hemangioma. (A) A superficial lesion affecting the left upper eyelid, forehead, and temple with a deep red, pebbly surface. (B) A deep lesion of the glabella (arrow) without any cutaneous discoloration. (C) A large mixed superficial and deep lesion of the scalp with features of both. (Courtesy of Timothy J. McCulley, MD).

Figure 2

A left lower eyelid hemangioma causing induced astigmatism. (Courtesy of Timothy J. McCulley, MD).

Figure 3

Magnetic resonance imaging. T1 post-contrast fat-suppressed axial (A) and sagittal (B) images demonstrate a well-circumscribed, brightly enhancing lesion of the left brow and upper eyelid.

Figure 4

Twin infants. The one on the right received oral corticosteroids and shows growth delay compared to his twin. (Courtesy of Timothy J. McCulley, MD).

Figure 5

Involution of hemangioma following intralesional steroid injection. (A) Prior to treatment. (B) One week following injection, there is a mild decrease in the size of the lesion. (C) Four weeks later, marked improvement in lesion size has occurred.

Figure 6

Intraoperative photograph. Despite repeated injection, the brow hemangioma continued to increase. It was excised with a subbrow incision without complication.