Skip to main content


Log in

Skin sequelae in patients with infantile hemangioma: a systematic review

  • Review
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript


Infantile hemangioma (IH) is the most common vascular tumor in infancy. Although IHs can regress spontaneously, some problematic IHs still need treatment. However, either treated or untreated IHs may leave skin sequelae which can cause permanent disfigurement. Many studies evaluated the short-term efficacy of different kinds of treatment, but now, few studies are focusing on long-term skin sequelae. The objectives of our systemic review were to identify skin sequelae of IH thoroughly, determine specific factors associated with long-term IH sequelae, and learn how to improve these sequelae. We searched the following electronic databases: PubMed, EMBASE, Cochrane Library, and Three independent authors assessed the articles, and we reported this systemic review following PRISMA guidelines. Of 4448 articles initially identified, 62 underwent full-text review, and 17 met inclusion criteria. The overall rate of sequelae ranged from 5.3 to 93.5%. Factors associated with skin sequelae included patients’ demographics, hemangioma characteristics, and treatment factors.

What is Known:

• Infantile hemangioma is the most common vascular tumor during infancy.

• Infantile hemangiomas can regress spontaneously but either treated or untreated patients may leave permanent skin sequelae.

What is New:

• Skin sequelae in involuted Infantile hemangiomas are very common.

• It is significant to prevent, recognize, and improve skin sequelae of infantile hemangiomas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Bandera AIR, Sebaratnam DF, Wargon O, Wong L-CF (2021) Infantile hemangioma. part 1: Epidemiology, pathogenesis, clinical presentation and assessment. J Am Acad Dermatol 85(6):1379–1392

    Article  Google Scholar 

  2. Munden A, Butschek R, Tom W, Marshall JS, Poeltler DM, Krohne S, Ali´o A, Ritter M, Friedlander D, Catanzarite V et al (2014) Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies. Br J Dermatol 170(4):907–913

    Article  CAS  Google Scholar 

  3. Mulliken JB, Burrows PE, Fishman SJ (2013) Mulliken and Young’s vascular anomalies: hemangiomas and malformations. Oxford University Press, New York

    Book  Google Scholar 

  4. Léauté-Labrèze C, De La Roque ED, Hubiche T, Boralevi F, Thambo J-B, Taïeb A (2008) Propranolol for severe hemangiomas of infancy. New Eng J Med 358(24):2649–2651

  5. Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, Guibaud L, Baselga E, Posiunas G., Phillips RJ, Caceres H, Lopez Gutierrez JC, Ballona R et al (2015) A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med 372:735–746

  6. Kim KH, Choi TH, Choi Y, Park YW, Hong KY, Kim DY, Choe YS, Lee H, Cheon J-E, Park J-B et al (2017) Comparison of efficacy and safety between propranolol and steroid for infantile hemangioma: a randomized clinical trial. JAMA Dermatol 153(6):529–536

    Article  Google Scholar 

  7. Novoa M, Baselga E, Beltran S, Giraldo L, Shahbaz A, Pardo- Hernandez H, Arevalo-Rodriguez I (2018) Interventions for infantile hae- mangiomas of the skin. Cochrane Database of Syst Rev (4)

  8. Moher D, Liberati A, Tetzlaff J, Altman DG, Group* P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine 151(4):264–269

  9. Higgins JP, Altman DG, Gøtzsche PC, Ju¨ni P, Moher D, Oxman AD, Savovi´c J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. Bmj 343

  10. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  Google Scholar 

  11. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605

    Article  Google Scholar 

  12. Zhang L, Wu H-W, Yuan W, Zheng J-W (2017) Propranolol therapy for infantile hemangioma: our experience. Drug Des Dev Ther 11:1401

    Article  CAS  Google Scholar 

  13. Baselga E, Roe E, Coulie J, Mun˜oz A, I, Puig L, FZ, Boon LM, McCuaig C, Hernandez-Mart´ın A, Gich I, Puig L (2016) Risk factors for degree and type of sequelae after involution of untreated hemangiomas of infancy. JAMA Dermatol 152(11):1239–1243

    Article  Google Scholar 

  14. Bauland CG, Lüning TH, Smit JM, Zeebregts CJ, Spauwen PH (2011) Untreated hemangiomas: growth pattern and residual lesions. Plast Reconst Surg 127(4):1643–1648

    Article  CAS  Google Scholar 

  15. Chang S-J, Qiao C, Chang L, Gao W, Jin Y, Ma G, Qiu Y, Lin X (2019) A 7-year follow-up study on untreated deep or mixed facial infantile hemangioma in east-Asian patients: when propranolol was not yet an option. J Dermatol 46(11):962–966

    Article  CAS  Google Scholar 

  16. Chang S-J, Yu W, Gu Y, Han Y, Shang Y, Chang L, Jin Y, Ma G, Qiu Y, Lin X (2019) Location of infantile hemangioma is a predictor of volumetric sequelae after involution. J Dermatol 46(5):371–375

    Article  Google Scholar 

  17. Chen W, Liu S, Yang C, Yang S (2015) Clinical efficacy of the 595 nm pulsed dye laser in the treatment of childhood superficial hemangioma – analysis of 10-year application in Chinese patients. J Dermatol Treat 26(1):54–58

    Article  CAS  Google Scholar 

  18. Lin P-F, Chen F-C, Chen J-Y, Jiang C-H (2020) Aesthetic outcome of intralesional injection of lauromacrogol as a single-agent treatment for uncomplicated infantile hemangiomas: a long-term follow-up study. J Dermatol 47(10):1119–1125

    Article  CAS  Google Scholar 

  19. Tangtatco JA, Freedman C, Phillips J, Pope E (2018) Surgical treatment outcomes of infantile hemangioma in children: does prior medical treatment matter. Pediatr Dermatol 35(6):418–419

    Article  Google Scholar 

  20. Yu Z, Cai R, Chang L, Qiu Y, Chen X, Chen Q, Ma G, Jin Y, Lin X (2019) Clinical and radiological outcomes of infantile hemangioma treated with oral propranolol: a long-term follow-up study. J Dermatol 46(5):376–382

    Article  CAS  Google Scholar 

  21. Jiang J-C, Xu Q, Fang S, Gao Y, Jin W-W (2021) Sequelae after involution of superficial infantile hemangioma: early intervention with 595-nm pulsed laser combined with 755-nm long-pulsed alexandrite laser versus wait-and-see. Clin Cosmet Investig Dermatol 14:37

    Article  Google Scholar 

  22. Couto RA, Maclellan RA, Zurakowski D, Greene AK (2012) Infantile hemangioma: clinical assessment of the involuting phase and implications for management. Plast Reconstr Surg 130(3):619–624

    Article  CAS  Google Scholar 

  23. Chen W, Yang C, Liu S, Yang S (2014) Curative effect study of pulsed dye laser in the treatment of 43 patients with hand infantile hemangioma. Eur J Dermatol 24(1):76–79

    Article  CAS  Google Scholar 

  24. Chelleri C, Monzani NA, Gelmetti C, Milani GP, Fossali EF, Galeone C, Cavalli R (2020) Residual lesions after pharmacological and dye-laser treatment of infantile hemangiomas: critical review of 432 cases. Lasers Surg Med 52(7):597–603

    Article  Google Scholar 

  25. Baselga E, El Hachem M, Diociaiuti A, Carnevale C, Downey C, Roe E, Mascaro P, Neri I, Leuzzi M, Bernabeu-Wittel J et al (2021) Sequelae following infantile haemangiomas treated with propranolol. Eur J Dermatol 31(6):785–790

    Article  CAS  Google Scholar 

  26. Mariani LG, Ferreira LM, Rovaris DL, Bonamigo RR, Kiszewski AE (2022) Infantile hemangiomas: risk factors for complications, recurrence and unaesthetic sequelae. An Bras Dermatol 97:37–44

    Article  Google Scholar 

  27. Dementieva N, Jones S (2016) The treatment of problematic hemangiomas in children with propranolol and 940 nm diode laser. J Pediatr Surg 51(5):863–868

    Article  Google Scholar 

  28. Zhao Z-L, Liu C, Wang Q-Z, Wu H-W, Zheng J-W (2021) Oral atenolol treatment for infantile hemangiomas: clinical analysis of 133 consecutive patients. Ann Transl Med 9(2)

  29. Colmant C, Powell J (2021) Medical management of infantile hemangiomas: an update. Pediatr Drugs 1–15 

Download references

Author information

Authors and Affiliations



All authors reviewed the manuscript. Wenni Li (first author): design of the work, data collection, data analysis, writing – original draft preparation, writing – review and editing; Jiajia Kang: design of the work, data collection, data analysis, data curation; Shan Bai: design of the work, data collection, data analysis, data curation; Liang Yuan: data curation; Jin Liu: data analysis; Yang B: data analysis, data curation, writing – review and editing; Jing Sun (co-corresponding author): conceptualization, supervision, writing – review and editing; Yun He (corresponding author): conceptualization, supervision, writing and review & editing, final approval of the version to be published.

Corresponding authors

Correspondence to Jing Sun or Yun He.

Ethics declarations

Ethics approval

This article does not contain any studies with human participants performed by any of the authors.

Consent to participate

Not applicable to this manuscript.

Consent for publication

Not applicable to this manuscript.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, W., Kang, J., Bai, S. et al. Skin sequelae in patients with infantile hemangioma: a systematic review. Eur J Pediatr 182, 479–488 (2023).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: