Reassuring parents that most hemangiomas will resolve by school age with no intervention, leaving little or no scarring, Cohen said, presents a big challenge to physicians. Hemangiomas occur in girls three times more often than in boys. Half appear on the head and neck, prompting parents to seek active therapy. Hemangiomas that obstruct the airway, compromise vision, bleed, or involve blood flow sufficient to create a risk of heart failure need treatment. According to Cohen, pulsed-dye laser therapy may be appropriate for ulcerated hemangiomas, but only if they are superficial, since the light penetrates only 2 mm below the skin's surface.
Deeper lesions are the ones most likely to cause problems.
Administration of systemic corticosteroids for 3 to 12 months remains the standard of care for complicated hemangiomas, despite concern about potential adverse effects. These include effects on the skin, such as thinning and telangiectasias, and a potential for delay in brain growth and hypertension, particularly in premature infants who have a higher incidence of hemangiomas than do full-term infants. These include conjunctival injection, erythema of the lips and oral pharynx, strawberry tongue, fissures of the lips, and swelling of the hands and feet. Development of perineal desquamation early in the acute phase, she said, can help make the diagnosis. Desquamation of the hands and feet, along with fever and cervical adenopathy, also commonly occurs.