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Treatment of infantile haemangiomas: recommendations of a European expert group

European Journal of Pediatrics volume 174, pages 855–865 (2015)Cite this article

Abstract

With a prevalence of 2.6–4.5 %, infantile haemangiomas (IH) represent the most common tumour of infancy. While the majority of IH does not require therapy and regresses spontaneously, about 10 % of IH exhibit complications such as obstruction, ulceration or disfigurement. With the advent of oral propranolol, many conventional treatment options have become obsolete. This paper summarizes current recommendations for management of complicated IH. These recommendations have been written by an expert group after a consensus process including bibliographic review, several drafts of synthesis, meetings with quantitative voting system and redaction of an approved final manuscript.

Conclusion: Oral propranolol is the first-line agent for the treatment of complicated IH.

What is Known:

• Infantile haemangiomas (IH) are the most common tumours of infancy. Within a very short period after its discovery and long before the publication of randomized controlled trials, propranolol has become the number one agent for the treatment of complicated IH.

What is New:

• We report IH treatment recommendations of an international, interdisciplinary team of experts, based on an up-to-date review of the literature.

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Abbreviations

EMA:

European Medicines Agency

EPC:

Endothelial progenitor cells

FDA:

Food and Drug Administration (USA)

GLUT1:

Glucose transporter 1

HemSC:

Haemangioma stem cells

HIF-1:

Hypoxia-inducible factor

IH:

Infantile haemangioma

Nd:YAG:

Neodym-dotted Yttrium-aluminum-granate laser

PHACE:

Posterior fossa-haemangioma-arterial-cardiac-eye anomaly

RCT:

Randomized controlled trial

VEGF(R):

Vascular endothelial growth factor (receptor)

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Acknowledgments

We thank Laboratoires Pierre Fabre Dermatologie, Inc., for sponsoring the meeting in Castres and for the technical support of the consensus process. Drs. Etienne André and Alain Delarue kindly acted as moderators of the discussion process.

Compliance with ethical standards

The manuscript complies to the ethical rules applicable to the European Journal of Pediatrics.

Conflict of interest

Pierre Fabre Inc., France, hosted the initial meeting of the Expert Group in Castres/France.

Author’s contributions

All coauthors attended the initial meeting and participated in the discussion of topics and in the design of the consensus paper. PHH wrote the initial draft of the manuscript which was then circulated to all coauthors. Comments and annotations of all coauthors were included in subsequent drafts. The final version of the manuscript was approved by all coauthors.

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Authors and Affiliations

  1. Department of Paediatrics and Paediatric Dermatology, Catholic Children’s Hospital Wilhelmstift, Liliencronstr. 130, Hamburg, 22149, Germany

    Peter H. Hoeger

  2. Department Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK

    John I. Harper

  3. Department Paediatric Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain

    Eulalia Baselga

  4. M3C-Department Paediatric Cardiology, Université Paris Descartes, Hôpital Universitaire Necker-Enfants Malades, Paris, France

    Damien Bonnet

  5. Division Plastic Surgery, Ctr. Vascular Anomalies, Cliniques Universitaires St Luc, Brussels, Belgium

    Laurence M. Boon

  6. Clinical Epidemiology Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy

    Marta Ciofi Degli Atti

  7. Dermatology Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy

    Maya El Hachem

  8. Department of Dermatology, Maasstad Hospital, Rotterdam, Netherlands

    Arnold P. Oranje

  9. Centre for Laser and Vascular Anomalies, Department of Dermatology, Skane University Hospital, Malmö, Sweden

    Agneta Troilius Rubin

  10. Department of Dermatology, University Hospital and University Children’s Hospital, Zürich, Switzerland

    Lisa Weibel

  11. Department Paediatric Dermatology, CHU de Bordeaux, HôpitalPellegrin-Enfants, Bordeaux, France

    Christine Léauté-Labrèze

Authors
  1. Peter H. Hoeger
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  2. John I. Harper
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  3. Eulalia Baselga
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  4. Damien Bonnet
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  5. Laurence M. Boon
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  6. Marta Ciofi Degli Atti
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  7. Maya El Hachem
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  8. Arnold P. Oranje
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  9. Agneta Troilius Rubin
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  10. Lisa Weibel
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  11. Christine Léauté-Labrèze
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Corresponding author

Correspondence to Peter H. Hoeger.

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Communicated by Beat Steinmann

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Hoeger, P.H., Harper, J.I., Baselga, E. et al. Treatment of infantile haemangiomas: recommendations of a European expert group. Eur J Pediatr 174, 855–865 (2015). https://doi.org/10.1007/s00431-015-2570-0

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  • DOI: https://doi.org/10.1007/s00431-015-2570-0

Keywords

  • Haemangioma
  • Complications
  • Therapy
  • Infants