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Abstract

Infantile hemangiomas or hemangiomas of infancy are the most common benign cutaneous tumors of infancy. The pathogenesis of infantile hemangiomas remains unclear. They are composed by masses of capillaries lined by endothelial cells that have a unique vascular phenotype demonstrated by the erythrocyte-type glucose transporter protein staining (GLUT-1). Infantile hemangiomas present shortly after birth most often as well-demarcated, flat, and erythematous red patches. They follow a predictable course with three distinct phases: proliferation (8–18 months), involuting phase (1–7 years), and involuted. They are classified as superficial, deep, or combined.

Another subclassification of IH is focal, segmental, indeterminate, and multifocal. Multifocal can be associated with visceral involvement. Most hemangiomas are asymptomatic and can be managed with close observation. A significant minority of IH (20 %) during the rapid growth phase are associated with important complications such as ulceration, bleeding, risk for permanent disfigurement, compromised organ function (vision and airway obstruction), or high-output cardiac failure. Segmental hemangiomas are frequently associated with structural anomalies and/or visceral hemangiomas.

Patients with facial segmental hemangiomas and likewise with lumbosacral segmental hemangiomas should undergo imaging studies to rule out PHACE syndrome and PELVIS/SACRAL/LUMBAR syndrome, respectively.

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References

  1. Bowers RE, Graham EA, Thominson KM (1960) The natural history of the strawberry nevus. Arch Dermatol 82:667–670

    Article  Google Scholar 

  2. Powell TG, West CR, Pharoah PO, Cooke RW (1987) Epidemiology of strawberry hemangioma in low birth weight infants. Br J Dermatol 116:635–641

    Article  CAS  PubMed  Google Scholar 

  3. Bruckner AL, Frieden IJ (2003) Hemangiomas of infancy. J Am Acad Dermatol 48:477–493

    Article  PubMed  Google Scholar 

  4. Chang LC, Haggstrom AN, Drolet BA, Hemangioma Investigator Group et al (2008) Growth characteristics of infantile hemangiomas: implications for management. Pediatrics 122(2):360–367

    Article  PubMed  Google Scholar 

  5. Drolet BA, Esterly NB, Frieden IJ (1999) Hemangiomas in children. N Engl J Med 341(3):173–181

    Article  CAS  PubMed  Google Scholar 

  6. Chiller KG, Passaro D, Frieden IJ (2002) Hemangiomas of infancy: clinical characteristics, morphologic subtypes, and their relationship to race, ethnicity, and sex. Arch Dermatol 138(12):1567–1576

    Article  PubMed  Google Scholar 

  7. Waner M, North PE, Scherer KA et al (2003) The nonrandom distribution of facial hemangiomas. Arch Dermatol 139(7):869–875

    Article  PubMed  Google Scholar 

  8. Haggstrom AN, Lammer EJ, Schneider RA et al (2006) Patterns of infantile hemangiomas: new clues to hemangioma pathogenesis and embryonic facial development. Pediatrics 117(3):698–703

    Article  PubMed  Google Scholar 

  9. Waner M, Suen JY (1999) The natural history of hemangiomas. In: Waner M, Suen JY (eds) Hemangiomas and vascular malformations of the head and neck. A John Wiley & Sons, Inc., New York, pp 13–45

    Google Scholar 

  10. Martínez-Pérez D, Fein NA, Boon LM, Mulliken JB (1995) Not all hemangiomas look like strawberries. Pediatr Dermatol 12(1):1–6

    Article  PubMed  Google Scholar 

  11. Mulliken JB, Fishman SJ, Burrows PE (2000) Vascular anomalies. Curr Probl Surg 37:519–584

    Article  Google Scholar 

  12. Brandling-Bennett HA, Metry DW, Baselga E et al (2008) Infantile hemangiomas with unusually prolonged growth phase: a case series. Arch Dermatol 144(12):1632–1637

    Article  PubMed  Google Scholar 

  13. Blei F, Isakoff M, Deb G (1997) The response of parotid hemangiomas to the use of systemic interferon alfa-2a or corticosteroids. Arch Otolaryngol Head Neck Surg 123(8):841–844

    Article  CAS  PubMed  Google Scholar 

  14. Shu K, Frieden I (2010) Infantile hemangioma with minimal or arrested growth. Arch Dermatol 146(9):971–976

    Google Scholar 

  15. Mulliken JB, Marler JJ, Burrows PE, Kozakewich HP (2007) Reticular infantile hemangioma of the limb can be associated with ventral-caudal anomalies, refractory ulceration, and cardiac overload. Pediatr Dermatol 24(4):356–362

    Article  PubMed  Google Scholar 

  16. Corella F, Garcia-Navarro X, Ribe A, Alomar A, Baselga E (2008) Abortive or minimal growth hemangiomas. J Am Acad Dermatol 58(4):685–690

    Article  PubMed  Google Scholar 

  17. North PE, Waner M, Mizeracki A et al (2000) GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. Hum Pathol 31(1):11–22

    Article  CAS  PubMed  Google Scholar 

  18. Haggstrom AN, Drolet BA, Baselga E et al (2006) Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics 118(3):882–887

    Article  PubMed  Google Scholar 

  19. Kim HJ, Colombo M, Frieden IJ (2001) Ulcerated hemangiomas: clinical characteristics and response to therapy. J Am Acad Dermatol 44:962–972

    Article  CAS  PubMed  Google Scholar 

  20. Chamlin SL, Haggstrom AN, Drolet BA et al (2007) Multicenter prospective study of ulcerated hemangiomas. J Pediatr 151(6):684

    Article  PubMed  Google Scholar 

  21. Shin HT, Orlow SJ, Chang MW (2007) Ulcerated haemangioma of infancy: a retrospective review of 47 patients. Br J Dermatol 156(5):1050–1052

    Article  CAS  PubMed  Google Scholar 

  22. Bilyk JR, Adamis AP, Mulliken JB (1992) Treatment options for periorbital hemangioma of infancy. Int Ophthalmol Clin 32(3):95–109

    Article  CAS  PubMed  Google Scholar 

  23. Dubois J, Milot J, Jaeger B, McCuaig C, Rousseau E, Powell J (2006) Orbit and eyelid hemangiomas: is there a relationship between location and ocular problems? J Am Acad Dermatol 55:614–619

    Article  PubMed  Google Scholar 

  24. Millischer-Bellaiche AE, Enjolras O, Andre C, Bursztyn J, Kalifa G, Adamsbaum C (2004) Eyelid hemangiomas in infants: contribution of MRI. J Radiol 85:2019–2028

    Article  CAS  PubMed  Google Scholar 

  25. Ceisler EJ, Santos L, Blei F (2004) Periocular hemangiomas: what every physician should know. Pediatr Dermatol 21:1–9

    Article  PubMed  Google Scholar 

  26. Orlow SJ, Isakoff MS, Blei F (1997) Increased risk of symptomatic hemangiomas of the airway in association with cutaneous hemangiomas in a beard distribution. J Pediatr 131(4):643–646

    Article  CAS  PubMed  Google Scholar 

  27. Suh K-Y, Rosbe C, Meyer A, Frieden I (2011) Extensive airway hemangiomas in two patients without beard hemangiomas. Pediatr Dermatol 28(3):347–348

    Article  PubMed  Google Scholar 

  28. Sherrington CA, Sim DKY, Freezer NJ et al (1997) Subglottic hemangioma. Arch Dis Child 76:458–459

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Rahbar R, Nicollas R, Roger G et al (2004) The biology and management of subglottic hemangioma: past, present, future. Laryngoscope 114(11):1880–1891

    Article  PubMed  Google Scholar 

  30. Golitz LE, Rudikoff J, O’Meara OP (1986) Diffuse neonatal hemangiomatosis. Pediatr Dermatol 3(2):145–152

    Article  CAS  PubMed  Google Scholar 

  31. Holden KR, Alexander F (1970) Diffuse neonatal hemangiomatosis. Pediatr Dermatol 46:411–421

    CAS  Google Scholar 

  32. Glick Z, Frieden I, Garzon M, Mully T, Drolet B (2012) Diffuse neonatal hemangiomatosis: an evidence-based review of case reports in the literature. J Am Acad Dermatol 67:898–903

    Article  PubMed  Google Scholar 

  33. Horii KA, Drolet BA, Frieden IJ et al (2011) Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas. Pediatr Dermatol 28(3):245–253

    Article  PubMed  Google Scholar 

  34. North PE, Kahn T, Cordisco MR, Dadras SS, Detmar M, Frieden IJ (2004) Multifocal lymphangioendotheliomatosis with thrombocytopenia: a newly recognized clinicopathological entity. Arch Dermatol 140:599–606

    Article  PubMed  Google Scholar 

  35. Frieden IJ, Reese V, Cohen D (1996) PHACE syndrome. The association of posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities. Arch Dermatol 132(3):307–311

    Article  CAS  PubMed  Google Scholar 

  36. Haggstrom A, Garzon M, Baselga E, Chamlin S, Frieden IJ, Holland K, Maguiness S, Mancini A, McCuaig C, Metry S, Morel K, Powell J, Perkins S, Siegel D, Drolet B (2010) Risk for PHACE syndrome in infants with large facial hemangiomas. Pediatrics 126:e418–e426

    Article  PubMed  Google Scholar 

  37. Bayer M, Frommelt P, Blei M, Cordisco M, Frieden I, Goddard D, Holland KE, Krol A, Maheshwar M, Metry D, Morel K, North P, Pope E, Shieh J, Southern J, Wargon O, Siegel D, Drolet B (2013) Congenital cardiac, aortic arch, and vascular bed anomalies in PHACE syndrome: The International PHACE Syndrome Registry Review. Am J Cardiol 112:1948–52

    Article  PubMed Central  PubMed  Google Scholar 

  38. Metry D, Heyer G, Hess C et al (2009) Consensus statement on diagnostic criteria for PHACE syndrome. Pediatrics 124(5):1447–1456

    Article  PubMed  Google Scholar 

  39. Metry D, Hawrot A, Altman C, Frieden I (2004) Association of solitary, segmental hemangiomas of the skin with visceral hemangiomatosis. Arch Dermatol 140:591–596

    Article  PubMed  Google Scholar 

  40. Girard C, Bigorre M, Guillot B et al (2006) PELVIS syndrome. Arch Dermatol 142(7):884–888

    Article  PubMed  Google Scholar 

  41. Stockman A, Boralevi F, Taieb A et al (2007) SACRAL syndrome: spinal dysraphism, anogenital, cutaneous, renal and urologic anomalies, associated with an angioma of lumbosacral localization. Dermatology 214(1):40–45

    Article  PubMed  Google Scholar 

  42. Iacobas I, Burrows PE, Frieden I, Drolet B (2012) LUMBAR: association between cutaneous infantile hemangiomas of lower body and regional congenital anomalies. J Pediatr 157(5):795–801 e1–7

    Article  Google Scholar 

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Cordisco, M.R. (2015). Hemangiomas: Clinical Picture. In: Mattassi, R., Loose, D., Vaghi, M. (eds) Hemangiomas and Vascular Malformations. Springer, Milano. https://doi.org/10.1007/978-88-470-5673-2_7

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  • DOI: https://doi.org/10.1007/978-88-470-5673-2_7

  • Publisher Name: Springer, Milano

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