Prognostic Factors for Long-term Aesthetic Outcome of Infantile Haemangioma Treated with Beta-blockers

Abstract

Parents of infants treated with beta-blockers for infantile haemangioma are often concerned about the long-term aesthetic outcome. This cross-sectional study assessed the influence on the long-term aesthetic outcome of characteristics of the infantile haemangioma, the beta-blocker treatment, and the infant. The study included 103 children aged 6-12 years, treated with beta-blockers (propranolol or atenolol) for infantile haemangioma during infancy (age at treatment initiation ≤1 year) for ≥6 months. Dermatologists and parents scored the Patient Observer Scar Assessment Scale, and the child scored a visual analogue scale. Dermatologists identified whether telangiectasia, fibrofatty tissue, and atrophic scar tissue were present. The long-term aesthetic outcome of infantile haemangioma was judged more negatively by dermatologists and parents in case of a superficial component, ulceration, older age at treatment initiation, higher cumulative dose, and/or shorter follow-up time. According to children, infantile haemangioma located on the head had better aesthetic outcome than infantile haemangioma located elsewhere. Close monitoring, particularly of infantile haemangioma with a superficial component, is essential for early initiation of treatment, and to prevent or treat ulceration. These outcome data can support parental counselling and guide treatment strategy.

Fig. 1

Photographs of the infantile haemangioma before beta-blocker treatment initiation and at follow-up. (A) Female with a large (>50 mm) ulcerated superficial and segmental infantile haemangioma located on the head, before initiation of beta-blocker treatment (propranolol) at the age of 3 months. (B) The residual lesion was scored during the follow-up visit, when the child was 6 years old. The paediatric dermatologist gave an Observer Scar Assessment Scale score of 5, parents gave a Patient Scar Assessment Scale score of 4, and the child gave a visual analogue scale score of 2. The paediatric dermatologist also determined that telangiectasia were present, and that fibrofatty tissue and atrophic scar tissue were absent. Both parents gave written permission to publish these photographs.

Fig. 2

Photographs of the infantile haemangioma before beta-blocker treatment initiation and at follow-up. (A) A female with a small (< 30 mm) superficial and focal infantile haemangioma with a tendency to ulceration located on the lower eyelid, before initiation of beta-blocker treatment (atenolol) at the age of 2 months. (B) The residual lesion was scored during the follow-up visit, when the child was 7 years old. The paediatric dermatologist gave an Observer Scar Assessment Scale (OSAS) score of 1, parents gave a Patient Scar Assessment Scale (PSAS) score of 2, and the child gave a visual analogue scale (VAS) score of 0. The paediatric dermatologist also determined that telangiectasia, fibrofatty tissue, and atrophic scar tissue were absent.