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Review
. 2024 Nov 18;11(11):1397.
doi: 10.3390/children11111397.

Diagnosis and Treatment of Infantile Hemangioma from the Primary Care Paediatricians to the Specialist: A Narrative Review

Francesco Bellinato  1 , Maria Marocchi  2 , Luca Pecoraro  2 , Marco Zaffanello  2 , Micol Del Giglio  1 , Giampiero Girolomoni  1 , Giorgio Piacentini  2 , Erika Rigotti  2
Affiliations
Review

Diagnosis and Treatment of Infantile Hemangioma from the Primary Care Paediatricians to the Specialist: A Narrative Review

Francesco Bellinato et al. Children (Basel). .

Abstract

Infantile haemangiomas (IHs) affect 3-10% of infants, 10% of whom need topical or systemic beta-blocker therapy. Propranolol is the first choice for IHs with a high risk of complications. Since more than half of IHs leave a permanent mark, to reduce outcomes, it is essential to start oral propranolol (2-3 mg/kg/day in 2 doses/day) within the 5th month of life (i.e., during the proliferative phase) and to complete the therapy cycle for at least 6 months. This review aims to summarise the epidemiology, clinical presentation, diagnosis, and treatment of IHs and to highlight the importance of proper referral to specialised hub centres. Patients with vascular anomalies, particularly those suspected of having IH, should be referred to a specialised centre for accurate diagnosis, management by a multidisciplinary team, and timely treatment. IHs may pose life-threatening, functional, and aesthetic risks or may ulcerate. Segmental infantile haemangioma of the face/neck and the lumbosacral regions can be associated with various malformations. To ensure timely specialist evaluation and treatment to reduce the potential risk of complications, it is essential to identify high-risk IHs rapidly. The Infantile Haemangioma Referral Score (IHReS) scale is an important tool to assist primary care paediatricians and general dermatologists.

Keywords: children; infantile haemangioma; infants; propranolol.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
A 12-week-old female infant presented with a mixed IH extending to the neck, chin, and sternal region, requiring multidisciplinary management for treatment with propranolol, including ultrasound and ENT consultation with fiber optic laryngoscopy (a). Telangiectatic residuals were observed after three months of treatment with propranolol (b).
Figure 2
Figure 2
A 6-week-old male infant presented with an ulcerated IH on the left malar region, treated with propranolol for aesthetic risk and multispecialty diagnostics to rule out PHACE syndrome (including ophthalmologic, ENT and cardiologic consultations, echocardiogram, ECG, and brain MRI) (a). Telangiectatic residuals at 12 months of age (b).
Figure 3
Figure 3
Referral pathways of IH from primary care to specialist centres.
See this image and copyright information in PMC

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