Infantile hemangioma. Part 1: Epidemiology, pathogenesis, clinical presentation and assessment

Completely ulcerated infantile hemangioma: a diagnostic challenge

The present case report describes a completely ulcerated infantile hemangioma (UIH) in a 5-month-old infant on the left proximolateral thigh initially misdiagnosed as pyoderma gangrenosum, sporotrichosis or atypical mycobacterial infection. Clinical assessment, histological findings, and GLUT‑1 immunohistochemistry confirmed the diagnosis of UIH. Systemic propranolol treatment led to rapid ulcer healing within 3 weeks and complete recovery without relapse after 18 months of treatment. The report emphasizes the diagnostic challenges, effective propranolol treatment and the importance of considering UIH in the differential diagnoses of solitary pediatric ulcers.

Comparative Evaluation of Laser Therapy for Infantile Hemangiomas: A Systematic Review of Clinical Outcomes and Treatment Considerations

BACKGROUND AND OBJECTIVES

Infantile hemangiomas (IHs) are the most common benign vascular tumors in infancy. While many resolve spontaneously, treatment is often required due to ulceration, functional impairment, or aesthetic concerns. Laser therapy, either alone or in combination with beta-blockers, has become a central therapeutic option. However, optimal laser parameters, efficacy for different IH types, and safety remain under investigation. This systematic review evaluates the effectiveness and safety of various laser treatments for IHs, focusing on lesion regression, treatment protocols, recurrence, and adverse events.

STUDY DESIGN/MATERIALS AND METHODS

A systematic search was conducted following PRISMA guidelines in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Studies published up to January 2025 were included. This review included 20 studies comprising a total of 2,856 patients. Included clinical studies evaluated laser therapy-alone or combined with pharmacological agents-and reported outcomes such as lesion regression, treatment duration, recurrence, and adverse effects.

RESULTS

The 595-nm pulsed dye laser (PDL) was the most studied and showed high efficacy for superficial IHs, with improvement rates up to 85%. The 1064-nm Nd:YAG laser was more effective for deeper lesions, achieving up to 87.57% regression. Combination therapies (e.g., PDL with propranolol or timolol) yielded better outcomes than monotherapy, with higher regression and lower recurrence. Dual-wavelength approaches also showed promise. Adverse effects were generally mild and infrequent.

CONCLUSION

Laser therapy is effective and well-tolerated for IHs. PDL is preferred for superficial lesions and Nd:YAG for deeper or mixed types. Standardized protocols are needed, and further research should refine therapeutic parameters and clinical guidelines.

Vulvar Hemangioma: A Review

Objectives: To review the clinical presentation, diagnostic approach, treatment strategies, and outcomes of vulvar hemangiomas, and to evaluate the consistency of management practices in the absence of standardized guidelines. Eligibility criteria: We included case reports, case series, and observational studies describing vulvar hemangiomas with clinical, histological, and management data in human subjects. Reviews, editorials, and studies unrelated to vulvar hemangiomas were excluded. Information sources: Systematic searches were conducted in PubMed, Embase, Scopus, and Web of Science up to 20 February 2025, with additional citation tracking. Results: 85 studies were included. Data were synthesized narratively due to heterogeneity in the study design and outcome reporting. Most studies described symptomatic lesions presenting as swelling, bleeding, or pain, often misdiagnosed as Bartholin cysts or varicosities. Treatment varied widely, including observation, surgical excision, embolization, and medical therapies. No evidence-based guidelines were identified. Conclusions: Vulvar hemangiomas are rare and frequently misdiagnosed. While asymptomatic lesions may be observed, symptomatic cases require individualized treatment. This review highlights the need for diagnostic vigilance and the development of standardized management protocols. Further research is needed to optimize clinical outcomes.

Impact of congenital heart disease on clinical outcomes of oral propranolol therapy for Infantile hemangiomas: a propensity score-matched analysis

BACKGROUND

Oral propranolol is the first-line treatment for Infantile hemangioma (IH). However, there is a lack of studies indicating whether the congenital heart disease (CHD) makes a difference in oral propranolol therapy (OPT). Previous studies have only confirmed the safety and efficacy of OPT in asymptomatic CHD children.

OBJECTIVE

This study aimed to evaluate and compare the clinical outcomes in pediatric patients with CHD and those without CHD following OPT and to assess risk factors that may contribute to recurrence.

METHODS

A total of 310 children who received OPT for IH between January 2020 and January 2023 were included in a retrospective study. The study aimed to assess demographic data, clinical symptoms, auxiliary examinations, and treatment effects. To compare clinical outcomes between children with and without CHD, one-to-one propensity score matching (PSM) was applied.

RESULTS

Among the 310 patients, 192 (61.94%) had CHD. After propensity-matching analysis, in the presence of CHD, the age at treatment withdrawal was significantly higher (15.0 months vs. 12.0 months, P < 0.05), the treatment duration was longer (12.0 months vs. 10.0 months, P < 0.05), and the recurrence rate was greater (32.9% vs. 5.3%, P < 0.001). No significant difference in the degree of regression was observed between the CHD and non-CHD groups.

CONCLUSION

Pediatric patients with CHD exhibit a later age at treatment withdrawal, a longer duration of therapy, and a higher recurrence rate compared to those without CHD.

A novel three-dimensional model of infantile haemangioma

BACKGROUND

Infantile haemangioma (IH) is vascular tumour in infants that exhibits rapid proliferation and angiogenesis followed by gradual involution. Ten per cent of cases are associated with disfiguring complications that require medical intervention with beta blockers, surgery or laser therapy.

OBJECTIVES

To improve our understanding of the disease mechanisms of IH with an in vitro three-dimensional model.

METHODS

We isolated and expanded CD31+ endothelial cells (HemECs) from patient-derived IH cell lines and grew them as spheroids in STEMdiffTM Endothelial Expansion Medium. The cells were then embedded in an extracellular matrix hydrogel with reduced growth factors to initiate angiogenic sprouting.

RESULTS

HemEC spheroids expressed CD31, glucose transporter 1, vascular endothelial growth factor receptor 2, CD44, vimentin and CD133 but not smooth muscle actin, indicating their similarity to immature IH blood vessels and their angiogenic potential. Proteomic analysis revealed similar homology in terms of protein expression in spheroids and IH tissue. The high-throughput application of the three-dimensional angiogenesis model was tested using propranolol to inhibit sprouting of spheroids with increased toxicity response.

CONCLUSIONS

This study reports the development of a three-dimensional model of IH that closely resembles the angiogenic features of IH for molecular analysis and drug screening.

Hemangioma of the abdominal wall in infancy

Hemangiomas are common benign vascular tumors in infancy, but their occurrence in the abdominal wall is rare. We report a 6-month-old female infant with a left-sided palpable abdominal wall mass. Ultrasound revealed a well-defined, vascularized soft tissue mass, but its precise location was unclear. Contrast-enhanced computed tomography showed a 4.3 × 4 × 4 cm heterogeneous mass with peripheral arterial enhancement and centripetal filling, raising suspicion for a vascular malformation or hemangioma. Magnetic resonance imaging confirmed a hypervascular mass in the lateral-posterior abdominal wall. Due to the lesion's high vascularity, percutaneous biopsy was considered high-risk, and complete surgical excision was performed. Histopathology confirmed a benign hemangioma with organized hematoma and dystrophic calcification. The patient had an uneventful recovery, with no recurrence observed at 40-day and 6-month follow-ups. This case highlights the importance of considering hemangiomas in the differential diagnosis of abdominal wall masses in infants.

Multifunctional Hydrogel Integrated Hemangioma Stem Cell-Derived Nanovesicle-Loaded Metal-Polyphenol Network Promotes Diabetic Flap Survival

Diabetes-associated skin defects represent a significant global health challenge. While flap grafts have been a preferred treatment for soft-tissue injuries in diabetic patients, their survival is often compromised by impaired vascularization, infection, and the adverse diabetic pathological microenvironment. To address these limitations, a hybrid photo-crosslinkable hydrogel (HPC) integrated hemangioma stem cell-derived nanovesicle (HemV)-loaded dual-metal-polyphenol network (dMPN) (HemV@dMPN/HPC) is developed. HemVs, derived from highly vascularized infantile hemangioma tissues, play a key role in promoting cell proliferation and angiogenesis. The dMPN facilitates the gradual release of copper (Cu2+) and magnesium ions (Mg2+), stimulating angiogenesis and mitigating inflammation. The HPC further sustains ion release while preserving the therapeutic efficacy of HemVs. Moreover, both HPC and Cu2+ act to confer antibacterial properties, further accelerating wound healing. This multifunctional HemV@dMPN/HPC platform offers a promising therapeutic strategy for treating large diabetic skin defects and can potentially improve flap graft survival.

Feature gene selection and functional validation of SH3KBP1 in infantile hemangioma using machine learning

BACKGROUND

Infantile hemangioma (IH) is a prevalent vascular tumor in infancy with a complex pathogenesis that remains unclear. This study aimed to investigate the underlying mechanisms of IH using comprehensive bioinformatics analyses and in vitro experiments.

METHODS

Using GSE127487, we identified differentially expressed genes (DEGs) in IH patients across three age groups (6, 12, and 24 months). GO and KEGG enrichment analyses were performed to identify biological processes and pathways. Immune cell infiltration, transcription factor target genes, miRNA expression, and metabolic pathways were analyzed. WGCNA classified IH patients into clusters, and machine learning algorithms identified key genes. The role of SH3KBP1, the most abundantly expressed gene in the skin, was investigated using shRNA knockdown and functional assays.

RESULTS

Gene expression in IH patients exhibited dynamic changes with age. Cellular processes and signaling pathways were consistent in the early proliferative phase, with gradual resolution in the late phase. Immune infiltration analysis revealed reduced immune cells in patients, while Pericytes were increased. NR5A1 was downregulated, while ZNF112, HSF4, and multiple miRNAs were upregulated with age. Metabolic pathways confirmed differences between proliferative and involution phases. WGCNA identified two clusters: Cluster 1 (angiogenesis and signal transduction) and Cluster 2 (metabolic and synthetic processes). Key genes, including SH3KBP1, were identified using machine learning algorithms. In vitro experiments demonstrated SH3KBP1's crucial role in cell migration and invasion.

CONCLUSION

This study unravels the gene expression and regulatory mechanisms of IH at different stages, providing new insights into its pathophysiology. SH3KBP1 offers a potential biomarker for future diagnostic and therapeutic strategies.

Oral propranolol and its impact on vital signs in hospitalized pediatric patients for the Management of Infantile Hemangiomas

BACKGROUND

Infantile hemangiomas (IH) affect 2%-10% of the pediatric population. The current standard treatment for complicated IH is oral propranolol. Propranolol initiation protocols vary depending on institution and may occur in an inpatient setting for patients <5-week-corrected-age, with a history of premature birth, and or with low weight to allow for heart rate (HR), blood pressure (BP), and glucose monitoring.

OBJECTIVE

Our study aimed to determine the clinical outcomes of monitoring inpatient propranolol initiation and to evaluate if complications occurred during admission.

METHODS

Retrospective chart review of patients seen at the University of Minnesota Department of Dermatology between January 01, 2012 and July 31, 2022 was completed. Inclusion criteria include less than 1 year of age at time of admission, a diagnosis of IH and or PHACE syndrome, and admission for propranolol initiation and monitoring.

RESULTS

Admissions for 78 pediatric patients were reviewed. After initiation of propranolol, significant decreases in BP (systolic p = .005; diastolic p = .002) and HR (p = .004) were noted; however, average BPs and HRs remained above the lower limit of normal. No patients experienced symptomatic hypoglycemia. No statistically significant or clinically meaningful differences in vital sign alterations were observed between patients <5 versus >5 kg; preterm vs term gestation; or <5-week-corrected-age versus >5-week-corrected-age.

DISCUSSION

Our findings complement current literature confirming that propranolol initiation is safe in pediatric patients. Propranolol initiation likely requires less laboratory and vital sign monitoring than currently performed for these patient populations.

Advanced Doppler Ultrasound Insights: A Multicenter Prospective Study on Healthy Skin

Background: There have been multiple studies on the use of Doppler ultrasound to define skin inflammation, but the visible vessels of healthy skin have yet to be described. Objective: This study aimed to evaluate the visible vessels of healthy skin using Doppler ultrasound. Methods: Prospective multicenter study using Doppler ultrasound to analyze healthy skin. The color percentage, flow velocity, and maximum vessel diameter were calculated. Results: 943 images from 152 patients were recorded. The most frequently used mode was color Doppler (40.6%), followed by power Doppler (30.4%). Visible vessels were detected in 18.23%; in positive Doppler images, color occupied less than 5%. The malar region exhibited the highest visible vessels. The 22 MHz probe detected smaller vessels with slower flows than the 18 MHz probe. Spectral Doppler showed peak systolic values of less than 10 cm/s and a vessel diameter of less than 1 mm. In most of the participating centers, the operators had less than 10 years of experience in performing skin ultrasound examinations. Sensitivity of the Doppler may vary according to the device. Conclusions: With the used ultrasound equipment, it was uncommon to visualize vessels in healthy skin. When seen, they covered less than 5% of the image with low flow and small size.

Research trends and hotspots of laser therapy in hemangioma: a bibliometric and visualization analysis

This bibliometric analysis aimed to analyze global research trends in laser therapy for hemangiomas, a common benign vascular tumor in children from 1977 to 2024. Publications in laser therapy for hemangiomas from 1977 to 2024 were retrieved from the Web of Science Core Collection (WoSCC) database, and only articles published in English were analyzed. Bibliometric and visual analyses were performed using VOSviewer, CiteSpace, and the R package "bibliometrix." A total of 1,028 publications from 66 countries and 4,199 authors were analyzed, showing an annual growth rate of 5.61%. The United States led with 365 articles and 11,713 citations. Major contributors included the University of California System and Harvard Medical School, and key journals were Lasers in Surgery and Medicine and Dermatologic Surgery. Pulsed dye laser (PDL) was the most studied laser type. Research focused on optimizing treatment safety, effectiveness, and management, especially in children. The rise of propranolol as a keyword highlighted its increasing role in hemangioma therapy, and the keyword like "classification" and "vascular anomalies" underlining the importance of accurate diagnosis and classification. This study highlights the growing importance of laser therapies for hemangiomas. Future research should explore combining propranolol with laser treatments and the role of precise diagnosis in improving treatment outcomes.

Recent Advances in Propranolol Hydrochloride Formulations for the Treatment of Infantile Hemangiomas

Infantile hemangiomas (IHs) are a kind of skin soft tissue benign tumors in infants, with a high incidence rate and significant harm. Rapid early proliferation can cause severe cosmetic deformities and organ development disorders. Propranolol Hydrochloride (PRH), a non-selective adrenergic β-receptor blocker, has become the first-line treatment for IHs due to its good efficacy and safety compared to other drugs. To further improve the bioavailability of PRH, deliver it more safely and effectively to the lesion site, and enhance patient compliance, researchers are continually developing new PRH formulations for the treatment of IHs. This article briefly introduced the pathogenesis of IHs and the therapeutic mechanism of PRH. It also provided a detailed overview of various new PRH formulations developed over the past 12 years for the treatment of IHs, including improved oral formulations, topical creams, gels, liposomes/nanoparticles, transdermal patches, microneedles, and targeted injectable formulations. This article summarized the development prospects and technical challenges of these new formulations. It aims to provide a comprehensive review of recent advances in new propranolol formulations and technologies for treating IHs, offering a reference for further research and application. At the same time, it is hoped that various new formulations of PRH can be safely and efficiently used in clinical practice in the future.

Cell Fate Regulation During the Development of Infantile Hemangioma

As the most common benign vascular tumor in infants, infantile hemangioma (IH) is characterized by rapid growth and vasculogenesis early in infancy, followed by spontaneous involution into fibrofatty tissues over time. Extensive evidence suggests that IH originates from hemangioma stem cells (HemSCs), a group of stem cells with clonal expansion and multi-directional differentiation capacity. However, the intricate mechanisms governing the cell fate transition of HemSCs during IH development remain elusive. Here we comprehensively examine the cellular composition of IH, emphasizing the nuanced properties of various IH cell types and their correlation with the clinical features of the tumor. We also summarize the current understanding of the regulatory pathways directing HemSC differentiation into endothelial cells (ECs), pericytes, and adipocytes throughout the stages of IH progression and involution. Furthermore, we discuss recent advances in unraveling the transcriptional and epigenetic regulation of EC and adipocyte development under physiological conditions, which offer crucial perspectives for understanding IH pathogenesis.

Integrative Bioinformatics Analysis of Pyroptosis-Related Genes and Analysis of Immune Cell Infiltration in Infantile Hemangioma Regression

Background

Infantile hemangiomas (IHs) are characterized by spontaneous regression, and their pathogenesis involves immune cell infiltration and programmed cell death. The molecular pathways and mechanisms involved in pyroptosis in IHs are still unclear. This study aimed to identify genes related to pyroptosis in IH regression by bioinformatics methods and to explore the effects of these pyroptosis-related genes (PRGs) on disease pathology and immune cell infiltration.

Methods

The microarray dataset GSE127487 was assessed to identify differentially expressed genes (DEGs) between proliferation-phase IH (PIHs) and involution-phase IH (IIHs). The DEGs that overlapped with PRGs were considered IH-PRGs. The IH-PRGs were validated and subjected to functional enrichment analysis and Genomes pathway analyses. Gene set enrichment analysis (GSEA) was also performed to analyse the biological significance of the DEGs. The NetworkAnalyst database was used to analyse the correlation network of IH-PRGs and miRNAs as well as that of IH-PRGs and transcription factors. The STRING online database and Cytoscape were used to identify the hub-IH-PRGs. Additionally, a single-sample GSEA algorithm was applied to assess immune cell infiltration in IHs, and correlation analysis was performed between the hub-IH-PRGs and infiltrating immune cells.

Results

Fourteen IH-PRGs were identified. IL6, EGFR, IRF1 and IL32 were identified as hub-IH-PRGs and displayed excellent diagnostic performance. Immune cell infiltration analysis revealed notable differences in CD8+ T cells, Tgd cells and Th17 cells between PIHs and IIHs. IL-6 was significantly positively correlated with Th17 cell infiltration and significantly negatively correlated with Tgd cell infiltration; EGFR was negatively correlated with Tgd cell infiltration; and IRF1 and IL32 were significantly negatively correlated with Th17 cell infiltration.

Conclusion

Four PRGs, namely, IL6, EGFR, IRF1 and IL32, may play a significant role in IH regression. This study provides insights into the molecular mechanisms underlying IH pathogenesis, highlighting the importance of pyroptosis and immune cell infiltration.

Efficacy and safety of atenolol vs. propranolol for treatment of infantile haemangioma: a narrative review

Infantile haemangioma (IH) remains the most common benign vascular tumour in childhood. Although most IH can be managed conservatively, a proportion of these lesions can cause disfigurement, ulceration or functional impairment, requiring prompt intervention. Propranolol, a lipophilic nonselective beta blocker, has been regarded as first-line therapy, following a serendipitous discovery of its use for IH in 2008. Although efficacious, it has been associated with adverse effects such as hypoglycaemia, bronchospasm, sleep disturbances and agitation in infant trials. Atenolol, a hydrophilic beta-1 selective blocker, has demonstrated similar efficacy and potentially greater tolerability, being less likely to cause sleep disturbances given its inability to cross the blood-brain barrier, and a decrease in bronchial reactivity. The purpose of this review is to explore and critique current knowledge about the efficacy and safety of propranolol vs. atenolol in children with an IH. In total, seven studies comparing the two beta blockers were identified in our search. Atenolol appeared to be as efficacious as propranolol and was associated with fewer central nervous system and bronchial-related adverse events. Further research exploring the optimal dosing for atenolol, particularly for ulcerated or syndromic IHs, as well as the incidence and management of rebound growth would be beneficial.

Evaluation of Five Ready-to-Use Bases for the Topical Administration of Propranolol Hydrochloride to Treat Infantile Hemangioma

Background/Objectives: Since 2008, following clinical studies conducted on children that revealed the ability of the β-adrenergic antagonist propranolol to inhibit capillary growth in infantile hemangiomas (IHs), its oral administration has become the first-line treatment for IHs. Although oral propranolol therapy at a dosage of 3 mg/kg/die is effective, it can cause systemic adverse reactions. This therapy is not necessarily applicable to all patients. Topical skin applications could help maintain a high drug concentration at local sites and also represent a characteristically easy method of administration for pediatric patients. Because no topical propranolol dosage forms are commercially available, such formulations may be prepared at hospitals and pharmacies. Methods: In the present study, we identified a simple method for preparing topical propranolol hydrochloride formulations at 1% w/w with five commercial ready-to-use bases and evaluated the pharmaceutical profiles. The physical stability of the extemporaneous formulations was predicted by performing an accelerated centrifuge test and assessed by visual inspection after one month storage at 25 °C. The chemical stability of the drug in the five formulations was assessed by using a high-performance liquid chromatography (HPLC) method. In vitro drug-release and permeability experiments were conducted through synthetic membranes and the outer pavilion of a pig's ear by utilizing Franz-type diffusion cells. Results: The results indicated that the release of the drug was significantly influenced by the internal structure and physicochemical properties of each base. Conclusions: Specifically, the formulations prepared with the hydrophilic bases could be easily prepared and yield satisfactory results, representing a potential effective therapy for IHs in pediatric patients.

The Evaluation, Diagnosis, and Management of Infantile Hemangiomas-A Comprehensive Review

Infantile hemangioma (IH) is the most common pediatric benign vascular tumor. Its pathogenesis is still poorly understood, and it usually appears during the first few weeks of life and follows a characteristic natural course of proliferation and involution. Most IHs are small, benign, resolve spontaneously, and do not require active treatment but only active observation. A minority of IHs are potentially problematic because they can cause life-threatening complications, permanent disfigurement, and functional impairment. Diagnosis is usually clinical, and propranolol is currently the mainstay of treatment. Other therapeutic modalities may be used alone or in combination, depending on the characteristics of the specific IH. New treatment options are being explored every day, and some are showing promising results. It is undeniable that therapeutic modalities for IHs must be selected based on the child's age, the size and location of the lesion, the presence of complications, the implementation conditions, and the possible outcomes of the treatment. The future of IH management will certainly be reflected in improved advanced imaging modalities, research into the genetic and molecular basis, the development of new pharmacological agents or techniques, and the development of standardized protocols, all to optimize outcomes with minimal side effects.

Efficacy and safety of propranolol tablets vs. oral solution in neonates with severe infantile hemangiomas: a retrospective study in China

The objective of this study was to evaluate the efficacy and safety of propranolol hydrochloride tablets and oral solution in neonates with severe IHs. A retrospective cohort study included 184 consecutive neonates diagnosed with severe IHs and treated with propranolol from January 2016 to June 2023. Of these, 126 patients received propranolol tablets, and 58 received propranolol oral solution. The primary outcome assessed the treatment response post-discontinuation of propranolol, while the key secondary outcome measured changes in the hemangioma activity score (HAS). Out of 184 participants, 138 (75.5%) were female. The mean age at treatment initiation was 16 days (range: 10-22) for the tablet group and 14 days (range: 8-24) for the oral solution group. Following treatment, effective response rates were 74.6% in the tablet group and 87.9% in the oral solution group (P = 0.04). Improvement in the HAS was 63.95% for the tablet group and 65.57% for the oral solution group (P = 0.35). Adverse reactions included diarrhea in 29.0% of tablet group and 12.9% of oral solution group (P = 0.01), and sleep disturbances in 20.6% of tablet group and 8.6% of oral solution group (P = 0.04). In terms of sequelae, telangiectasia occurred in 34.9% of tablet group and 17.2% of oral solution group (P = 0.01). Propranolol oral solution showed superior efficacy and safety compared to tablets in treating neonates with severe IHs, suggesting it should be prioritized as the preferred treatment option for this vulnerable population.

The 595-nm Wavelength Pulsed Dye Laser for Pediatric Port-Wine Birthmarks and Infantile Hemangiomas: A Systematic Review

INTRODUCTION

The 595-nm wavelength pulsed dye laser (PDL) is well-established in the treatment of vascular lesions. In June 2023, it received FDA clearance for the treatment of port-wine birthmarks (PWB) and infantile hemangiomas (IH) in the pediatric population.

OBJECTIVE

Review the evidence regarding the efficacy, safety, and implications of using PDL for management of pediatric PWB and IH.

METHODS

A systematic literature search was performed to identify peer-reviewed articles and clinical trials published between July 2002 and December 2022 in which PDL was used to treat pediatric PWB and IH.

RESULTS

After application of criteria, 33 journal articles with 7725 total patients were included. Only 16 (0.8%) of the 2,033 patients with PWB and 11 (0.2%) of the 5692 patients with hemangioma reported permanent adverse effects including scarring, keloids, or permanent pigmentation change, and none reported blindness or other serious injury. Good, excellent, or complete clearance after PDL-on average or in greater than 50% of patients-was reported in 17 of 19 studies (89%) that reported these measures for PWB, and seven of the seven studies (100%) for IH.

CONCLUSION

The 595-nm PDL is an excellent treatment option for early intervention in pediatric patients with PWB or IH.

Neonatal Cutaneous Vascular Anomalies

Vascular anomalies are broadly classified into 2 categories: vascular tumors and vascular malformations. Vascular anomalies frequently present as cutaneous lesions in infants. This review summarizes vascular anomalies that most commonly present as dermatologic lesions in the neonatal period, with a focus on the clinical findings, pathophysiology and histology, relevant radiographic findings, and management of common vascular anomalies such as infantile hemangiomas, congenital hemangiomas, and Kaposiform hemangioendothelioma, along with vascular malformations, including capillary, lymphatic, venous, and arteriovenous malformations.

Loss-of-Function Variant in PPP1R12A -Related Urogenital and/or Brain Malformation Syndrome: Expanded Phenotype of Sex Reversal

Differences of sex development (DSDs) are a heterogeneous group of congenital conditions in which chromosomal, gonadal, or anatomical sex does not match. The broad spectrum of phenotypes associated with DSDs requires accurate diagnosis, which influences the care and quality of life of affected patients. The decreasing costs of next-generation sequencing (NGS) and international research collaborations in rare diseases have allowed the identification of new genes associated with DSDs. Recently, Hughes et al. in 2020 reported the association of loss-of-function (LoF) variants in PPP1R12A with morphological anomalies of the midline, including holoprosencephaly and urogenital malformations, also known as genitourinary and/or brain malformation syndrome (OMIM #618820). In this report, we describe a Mexican individual with hypertelorism, multiple skin hemangiomas, testicular atrophy, and sex reversal, in whom a c.1880delC frameshift variant in PPP1R12A was detected by exome sequencing. Segregation analysis confirmed it as a de novo variant through Sanger sequencing. The main objective of this report is to expand PPP1R12A-related urogenital and/or brain malformation syndrome.

Neurodevelopmental Effects of Propranolol Treatment During Infancy in Infantile Hemangioma Patients

INTRODUCTION AND AIM

Propranolol is an effective treatment option for infantile hemangiomas, but there is still insufficient information about neurodevelopmental side effects of propranolol. In our study, the neurodevelopmental levels of infantile hemangioma patients receiving propranolol treatment were examined using the Bayley-III test.

METHOD

In our single-center, cross-sectional study, patients were recruited between 1 January 2020 and 31 December 2023. In total, 40 children (n1) diagnosed with hemangioma who received propranolol treatment and 31 children (n2) who were only under observation were included. A control group of 31 healthy children (n3) matched for age and gender was also included. The demographic, clinical, perinatal, and postnatal characteristics of the total 102 children were recorded from their medical records. Neurodevelopmental levels were assessed with the Bayley-III test. The significance level was set at (p < 0.05).

RESULTS

The Bayley-III test composite and percentile scores were used to evaluate the neurodevelopmental levels. Significant differences in motor functions were found between the treated and untreated groups compared to the healthy control group (p = 0.006 and p = 0.006). However, no significant differences were found in cognitive, language, and social-emotional skills. Cognitive, language, and motor functions were associated with maternal education level, and additionally, cognitive functions were also associated with paternal education level.

CONCLUSIONS

Propranolol has a relatively safer side effect profile, and therefore, it has been described as a safe agent. In our study, no significant effect of propranolol on neurodevelopment was observed. The difference in motor skills shown was mainly between the healthy control group (n3) and the treated and untreated group (n1 and n2), which led to the conclusion that the relevant difference could be due to factors other than propranolol itself.

Efficacy and safety of oral propranolol and topical timolol in the treatment of infantile hemangioma: a meta-analysis and systematic review

BACKGROUND

Propranolol, a nonselective β-blocker, is the first-line treatment for infantile hemangioma (IH). Topical timolol has recently been proposed as a novel IH treatment with fewer adverse effects. This study was conducted to compare the efficacy and safety of oral propranolol and topical timolol for treating IH.

METHODS

Studies were included after searching PubMed, Embase, Web of Science, and the Cochrane Library via the keywords of "propranolol", "timolol", "infantile hemangioma" and their synonyms. A meta-analysis with pooled odds ratios was performed using the fixed-effect model.

RESULTS

Seven articles with 2071 patients were included in this meta-analysis. Compared with topical timolol, oral propranolol had a greater response rate (OR = 2.12, P < 0.001), but it was also associated with a greater risk of adverse events (OR = 2.31, P < 0.001). For superficial IH, timolol demonstrated similar efficacy to propranolol (OR = 1.28, P = 0.34) but with fewer adverse events (OR = 2.30, P = 0.001). Additionally, compared with topical timolol, propranolol at a dosage of 2 mg/kg/d had a better response rate (OR = 2.62, P < 0.001), whereas the 1.0∼1.5 mg/kg/d propranolol group showed no significant difference (OR = 1.34, P = 0.38).

CONCLUSION

Oral propranolol presents superior therapeutic efficacy in the treatment of IH compared to topical timolol. However, topical timolol can serve as an alternative to oral propranolol for treating superficial IH, providing similar efficacy with fewer adverse effects. Additionally, propranolol at a dosage of 2 mg/kg/d offers greater efficacy with a comparable safety profile, whereas the 1.0∼1.5 mg/kg/d propranolol dosage shows no significant difference in efficacy compared to timolol but is associated with more adverse events.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024603724, identifier CRD42024603724.

Massive spinal epidural infantile hemangioma, image findings, and treatment: a case report and review of literature

Spinal involvement of infantile hemangiomas is rare with the predilection to involve the epidural space. A proper diagnosis might be challenging due to the atypical location and variable/inconsistent use of the International Society for the Study of Vascular Anomalies (ISSVA) classification by radiologists, pathologists, and clinicians. A proper diagnosis of epidural infantile hemangioma is key due to the different aggressiveness of the treatment options with inconstant literature regarding the best available treatment. Herein, we present a case of a massive epidural infantile hemangioma successfully treated with only beta-blocker. We discuss the clinical, MRI, CT, ultrasound, and histological features of this lesion as we review the literature with the objective of addressing some of the confusion surrounding the subject.

Optimizing Propranolol Therapy for Infantile Hemangiomas: The Role of the Multidisciplinary Team

BACKGROUND

Oral propranolol therapy is currently the first choice for infants with infantile hemangiomas (IHs) requiring systemic treatment. This study aims to evaluate the safety and effectiveness of oral propranolol therapy for IHs and to assess the role of a multidisciplinary medical team in supporting optimal treatment.

MATERIALS AND METHODS

Clinical data were retrospectively reviewed from medical records in 150 Japanese infants with IH treated with propranolol orally at Toranomon Hospital. Patients with problematic IH, such as tumor-type IH or IH with ulceration, were eligible for inclusion. Treatment was managed by a medical team consisting of pediatricians, dermatologists, pediatric nurses, pharmacists, and nutritionists. Patients' general conditions and vital signs, such as blood pressure, pulse rate, respiratory rate, and blood sugar, were closely monitored before, one hour, and two hours after drug administration.

RESULTS

Close collaboration among multidisciplinary medical team members allowed for accurate patient evaluation, contributing to the early detection of side effects, even if asymptomatic. When side effects were suspected, pediatricians and dermatologists discussed the need to reduce or discontinue the medication. Of the 150 patients, no one experienced severe side effects. Although five cases (3.3%) were suspected of having mild side effects (i.e., hypotension, n = 3; hypotension and hypoglycemia, n = 1; inspiratory stridor, n = 1), treatment could be continued by adjusting the dosage. One hundred twenty patients have completed the oral propranolol therapy with successful outcomes.

CONCLUSIONS

This study provided additional evidence of the safety and effectiveness of oral propranolol therapy in 150 Japanese infants with IH. A well-functioning multidisciplinary medical team is essential for optimal patient treatment.

Non-coding RNA in infantile hemangioma

Infantile hemangioma (IH) is the most common benign vascular tumor of infancy, but its pathogenesis has not been fully discovered. From the cellular perspective, CD133+ stem cells orchestrate the proliferation and development of IH. Regarding molecular mechanisms, hypoxia inducible factor-1α, renin-angiotensin system, and vascular endothelial growth factor are current study hotspots, while non-coding RNAs (ncRNAs) might be essential factors participating in this network. Therefore, this article reviewed published studies concerning the roles of ncRNAs in IH and listed noted miRNAs, lncRNAs, and circRNAs. Other ncRNAs, such as snRNAs, snoRNAs, and tsRNAs, though have not been examined in IH, are mentioned as well to discuss their potential functions. Due to the continuous development of sequencing technologies and computational pipelines for ncRNAs annotation, relevant studies will provide evidence to gradually enhance acknowledgments of ncRNAs' role in IH. The pathogenesis of IH might be revealed and the treatment protocol would be optimized in the future. IMPACT: Non-coding RNAs (ncRNAs) play critical roles in infantile hemangioma. This article thoroughly reviewed all ncRNAs (miRNAs, lncRNAs, and circRNAs) mentioned in previous studies regarding the pathogenesis of infantile hemangioma. Other ncRNAs are promising subjects for further investigation. This review introduced the emerging ncRNAs that need to be explored in IH.

Targeting ESM1 via SOX4 promotes the progression of infantile hemangioma through the PI3K/AKT signaling pathway

Background

Infantile hemangioma (IH) is the most prevalent benign vascular tumor in children, yet its pathogenesis remains incompletely understood. Research has established a strong association between SOX4 and tumor blood vessel formation. The objective of this study was to investigate the function and underlying mechanism of SOX4 in IH development with the aim of identifying novel therapeutic targets.

Methods

We identified the transcription factor SOX4 associated with IH through RNA-seq screening of IH microtumors and validated it in IH tissues. The effect of SOX4 on the biological behavior of CD31+ hemangioma-derived endothelial cells (HemECs) was investigated via in vitro cell experiments. In addition, RNA-seq analysis was performed on CD31+ HemECs with low expression levels of SOX4, and the target genes of SOX4 were identified. Finally, the effect of SOX4 on tumor angiogenesis was further elucidated through 3D microtumor and animal experiments.

Results

SOX4 is highly expressed in IH tissues and promotes the proliferation, migration, and angiogenesis of CD31+ HemECs. In addition, SOX4 binds to the endothelial cell-specific molecule 1 (ESM1) promoter to promote the progression of the PI3K/AKT signaling pathway. Finally, through IH 3D microtumor and animal experiments, SOX4 and ESM1 are shown to be tumorigenic genes that independently promote tumor progression.

Conclusions

SOX4 plays a crucial role in the progression of IH, and the SOX4/ESM1 axis may serve as a novel biomarker and potential therapeutic target for IH.

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

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.

A rare complication of infantile hemangioma: Kasabach-Merritt phenomenon

Infantile hemangiomas are the most common type of vascular tumors, affecting ~5% of infants within the first weeks of life. In rare instances, these tumors can lead to Kasabach-Merritt phenomenon (KMP), a life-threatening consumptive coagulopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, and hypofibrinogenemia. In the present case, a 20-month-old patient is diagnosed with KMP. This case report highlights the challenges in diagnosis and management, reinforcing the importance of multidisciplinary approach.

Advantages of Early Surgical Management of Periorbital Infantile Hemangiomas

Background: Early evaluation and treatment of periorbital infantile hemangiomas (POIH) were associated with lower rates of ophthalmological complications. Objective: To evaluate age and characteristics associated with improved anisometropic astigmatism (anisoastigmatism) and eye symmetry measured by diopters and a 5-point scale, respectively, in patients with POIH treated with surgical excision. Methods: A retrospective study was performed on patients with POIH. Patient characteristics and eye symmetry were analyzed between patients with resolved and unresolved anisoastigmatism after surgery. Statistical analyses included the Mann-Whitney U tests, chi-square tests, and linear regression models. Results: In total, 54 patients were included (male: 20, female: 34). Upper medial eyelid was the most commonly affected site (resolved: 45%, unresolved: 43%), followed by upper lateral and upper central. Fifty-six percent (31/55) had postoperative resolution of anisoastigmatism, whereas 44% (24/55) did not. Earlier surgical evaluation (median: 4.5 vs. 6.0 months, p = 0.047) and excision (median: 5.0 vs. 12.0 months, p = 0.005) were associated with reversible anisoastigmatism. Good and suboptimal eye symmetry were not associated with earlier surgical excision (median: 6 vs. 6.5 months, p = 0.87). Follow-up ranged from 1 month to 12 years. Conclusion: Earlier surgical excision was associated with reversing anisoastigmatism but was not significant for improving eye symmetry.

A 6-Week-Old Boy With Irritability and Abdominal Distension

A 6-week-old boy is brought to the hospital for fussiness and abdominal distension. He was febrile on presentation and was admitted to the hospital for further evaluation. On subsequent examinations, he continued to demonstrate abdominal distension and tenderness to palpation. Ultrasonography of the abdomen was performed and revealed a heterogeneous liver mass. With further diagnostics, a diagnosis was made and treatment initiated, with the infant experiencing resolution of his symptoms. Our panel of experts first discuss the management of an infant with abdominal distension, then discuss the evaluation of a liver mass in an infant, including oncologic, vascular, and infectious etiologies.

Recent advances in understanding the molecular basis of infantile haemangioma development

Infantile haemangioma (IH) - the most common vascular tumour of infancy - is comprised of diverse cell types, including endothelial cells, pericytes, fibroblasts and immune cells. IH is characterized by rapid proliferation followed by slow involution over 1-10 years. Most lesions regress spontaneously, but up to 10% can be disfiguring, with complications that require further medical treatment. Recent research has revealed the biological characteristics of IH, highlighting the involvement of angiogenesis and vasculogenesis during tumour formation. Gene expression profiling has provided vital insights into the underlying biological processes, with some of the key IH-related pathways identified, including vascular endothelial growth factor, the renin-angiotensin-aldosterone system, hypoxia-inducible factor 1α, Notch, platelet-derived growth factor, phosphoinositide 3-kinase/Akt/mammalian target of rapamycin, Janus kinase/signal transducers and activators of transcription, fibroblast growth factor, peroxisome proliferator-activated receptor-γ and insulin-like growth factor. Further evidence suggests extracellular matrix factors and hormone receptors regulate IH progression. In this review, we explore the molecular mechanisms involved in the proliferating, plateau and involuting phases of IH, identifying differentially expressed genes, targeted proteins and key signalling pathways. This knowledge will increase the broader understanding of vascular development, tissue remodelling and angiogenesis.

Identifying Potential Diagnostic and Therapeutic Targets for Infantile Hemangioma Using WGCNA and Machine Learning Algorithms

Infantile hemangioma (IH) is the most common benign vascular tumor during infancy and childhood and is characterized by abnormal vascular development. It is the most common vascular tumor and its related mechanisms and treatments remain a problem. IH-related biomarkers have been identified using transcriptome analysis and can be used to predict clinical outcomes. This study aimed to identify the key target genes for IH treatment and explore their possible roles in the IH pathophysiology. Gene records were acquired from the Gene Expression Omnibus database. Utilizing integrated weighted gene co-expression network examination, gene clusters were determined. Single-sample gene set enrichment analysis was performed to gauge immune infiltration. Essential genes were identified via Random Forest and Least Absolute Selection and Shrinkage Operator analyses. Ultimately, a set of five pivotal genes associated with the ailment was identified (NETO2, IDO1, KDR, MEG3, and TMSB15A). A nomogram for predicting IH diagnosis was constructed based on hub genes. The calibration curve showed valid agreement between the prediction and conclusion that the key genes in the model were clinically significant. Neuropilin and Tolloid-like 2 (NETO2) are closely associated with tumor development. The role value of NETO2 expression levels increased in hemangioma-derived endothelial cells (HemECs). After silencing NETO2, the growth and migration of cancer cells were significantly restrained. This study revealed the critical role of NETO2 in IH development, suggesting that targeting NETO2 may be effective in improving the therapeutic outcome of IH.

Oral propranolol for the treatment of hemangiomas in high-risk infants: safety and cost analysis of outpatient-initiated therapy

Objectives

To investigate the safety and cost analysis of oral propranolol treatment for high-risk infantile hemangiomas starting from the outpatient setting.

Methods

A total of 41 high-risk infantile hemangioma patients from outpatient settings and 43 from inpatient settings were selected for the study. After routine pre-treatment examinations, patients were administered propranolol in a stepwise incremental dosing regimen over three consecutive days in the outpatient clinic. Changes in heart rate, blood pressure and PR interval before and after medication were compared. On the 10th day post-medication, liver and kidney functions, fasting blood glucose, tumor ultrasonography, and electrocardiogram were re-evaluated. The costs of treatment starting from the outpatient clinic (including pre-treatment examinations and the first three days of treatment) were calculated and compared with those of similarly managed inpatient cases.

Results

The majority of patients exhibited a reduction in heart rate and blood pressure, as well as an extended PR interval after treatment of medication (P < 0.05), which remained within normal limits without clinical symptoms. On the 10th day post-medication, statistical differences in blood biochemistry and electrocardiograms were observed when compared to pre-treatment values (P < 0.05), but all values remained within normal ranges. No severe adverse reactions such as hypoglycemia occurred. Additionally, the cost of treatment from the outpatient clinic was significantly lower than that of inpatient care.

Conclusion

Oral propranolol treatment for high-risk infantile hemangiomas starting from the outpatient setting is associated with few adverse reactions and significantly reduced treatment costs. It is worthy of broader application in hospitals without dermatology wards.

Algorithm-based Management of Infantile Hemangiomas: Reducing Sequelae and Surgical Interventions

Background

In Japan, oral propranolol (PPL) and pulsed dye laser are available for infantile hemangioma (IH) treatment without patient cost-sharing. However, no standardized algorithm exists to guide treatment selection that balances efficacy, potential side effects, and aesthetic risks. This study presents a comprehensive approach utilizing a treatment algorithm and aesthetic risk scoring system.

Methods

This retrospective study analyzed outcomes from 156 patients with IHs. Oral PPL was used in IH patients with functional issues, whereas the rest underwent an aesthetic risk assessment that categorized them into low-, moderate-, or high-risk groups to guide treatment choices. Final treatment decisions depended on parental preference. The outcomes of algorithm-compliant and noncompliant patients were compared statistically.

Results

The risk score's interrater reliability was 0.973 (95% confidence interval 0.933-0.992), with a mean intrarater reliability of 0.968 ± 0.027 and a mean evaluation time of 14.1 ± 5.0 seconds per case. Among the 156 patients, 88% pursued the algorithm-recommended treatment, whereas 12% opted for different approaches. Algorithm-compliant patients experienced significantly fewer sequelae than did noncompliant patients (5% versus 33%, P < 0.001). Compared with noncompliant patients, algorithm-compliant patients tended to require shorter treatment durations (17.9 versus 25.4 mo, P = 0.08) and fewer laser sessions (5.8 versus 7.2, P = 0.30), with a younger age at resolution (21.3 versus 29.0 mo, P = 0.08).

Conclusions

Aesthetic concerns can be crucial for patients with IHs. This study introduces a comprehensive IH management algorithm to reduce the sequelae requiring surgical interventions and improve patients' quality of life.

Surface anatomy in dermatology: Part I-Clinical importance, diagnostic utility, and impact on medical management

This continuing medical education series reviews updated Delphi consensus surface anatomy terminology through the lens of common medical and procedural dermatology scenarios, helping to underscore high-yield points that can be readily integrated into clinical practice to support patient care. Part I of this series will discuss the current state of surface anatomy terminology in dermatology, outline implications of precise and consistent terminology, provide an illustrative overview of high-yield consensus terminology, highlight prominent landmarks that can aid in critical diagnoses, and relate the importance of precise terminology to medical management. Part II will draw upon consensus terminology to inform the management of cutaneous malignancies and support optimal outcomes in dermatologic procedures.

Thermal imaging for monitoring the treatment of hemangioma in pediatric patient: case report

Pediatric hemangiomas are benign vascular malformations or angiodysplasias characterized by the proliferation of endothelial cells in blood vessels. Their incidence is 4%-10% in children under 1 year of age, and they most frequently occur on the head and neck [1, 2]. In addition to causing facial deformities, facial hemangiomas can lead to both functional and aesthetic issues, often resulting in significant complications. These complications negatively impact the quality of life for patients and can also affect the psychological well-being and self-esteem of their families [3]. With the expected global smartphone penetration reaching 70% [4], this case report explores the use of smartphones integrated with thermographic cameras to monitor the involution of hemangiomas during sclerosing treatment. This approach represents a promising advancement in managing and assessing hemangioma treatment through accessible, real-time monitoring technology.

KLF2 Orchestrates Pathological Progression of Infantile Hemangioma through Hemangioma Stem Cell Fate Decisions

Infantile hemangioma (IH) is the most prevalent vascular tumor during infancy, characterized by a rapid proliferation phase of disorganized blood vessels and spontaneous involution. IH possibly arises from a special type of multipotent stem cells called hemangioma stem cells (HemSCs), which could differentiate into endothelial cells, pericytes, and adipocytes. However, the underlying mechanisms that regulate the cell fate determination of HemSCs remain elusive. In this study, we unveil KLF2 as a candidate transcription factor involved in the control of HemSCs differentiation. KLF2 exhibits high expression in endothelial cells in proliferating IH but diminishes in adipocytes in involuting IH. Using a combination of in vitro culture of patient-derived HemSCs and HemSCs implantation mouse models, we show that KLF2 governs the proliferation, apoptosis, and cell cycle progression of HemSCs. Importantly, KLF2 acts as a crucial determinant of HemSC fate, directing their differentiation toward endothelial cells while inhibiting adipogenesis. Knockdown of KLF2 induces a proadipogenic transcriptome in HemSCs, leading to impaired blood vessel formation and accelerated adipocyte differentiation. Collectively, our findings highlight KLF2 as a critical regulator controlling the progression and involution of IH by modulating HemSC fate decisions.

Placental ACE2 Expression: A Possible Pathogenetic Mechanism for Infantile Hemangiomas

ACE2 is a mono-carboxypeptidase with remarkable vasculo-protective properties, and its expression in the human placenta plays a central role in blood pressure homeostasis and fetal perfusion. Therefore, an alteration in the placental expression of ACE2 could be responsible for reduced placental perfusion and infantile hemangioma (IH) development. Study placentae were collected from patients affected by IHs who were referred to our Dermatology Clinic from 2016 to 2022, while control placentae were randomly collected while matching cases for gestational age. Immunohistochemical investigations were performed with a recombinant anti-ACE2 rabbit monoclonal antibody. A total of 47 placentae were examined, including 20 study placentae and 27 control ones. The mean placental weight was significantly lower in the study group (380.6 g vs. 502.3 g; p = 0.005), while subclinical chorioamnionitis occurred more frequently in the study group (20% vs. 0%, p = 0.03). The mean ACE2 expression was dramatically lower in the study group (χ2 = 42.1 p < 0.001), and the mean placental weight was significantly lower when ACE2 was not expressed compared to the 25-75% and >75% classes of expression (p < 0.05). This study demonstrated that ACE2, as a marker for tissue hypoxia, is dramatically hypo-expressed in placentae belonging to mothers who delivered one or more babies with IH compared to the controls.

Infantile Hemangioma with Minimal or Arrested Growth (IHMAG): A Retrospective Analysis of Clinical and Dermoscopic Diagnostic Clues

INTRODUCTION

Infantile hemangioma with minimal or arrested growth (IHMAG) is an unusual subset of infantile hemangioma, difficult to recognize because they are often mistaken for capillary malformation or other entities. Dermoscopic features of IHMAG have been described only in small case series so far.

OBJECTIVES

The aim of our study was to evaluate epidemiological, clinical, and dermoscopic features in 79 cases of IHMAG with a specific focus on neonates and toddlers with segmental complicated IHMAG and to provide a remarkable dermoscopic criterion to achieve diagnosis.

METHODS

This case series collected all the cases of IHMAG recorded in our Clinical Registry from January 2012 to March 2022.

RESULTS

A total of 79 cases of IHMAG were identified in our study; 53 (67.1%) were localized and 26 (32.9 %) were segmental. Patients showed some complications during follow-up such as ulceration and soft tissue anomalies. One PHACE syndrome and two LUMBAR syndromes were included. Our study highlights the main dermoscopic features differentiating IHMAG from infantile hemangiomas and capillary malformations in neonatal patients, highlighting the presence of enlarged unfocused telangiectatic vessels as remarkable clues.

CONCLUSIONS

This is a large case series described in the literature about this rare entity. We emphasize that segmental IHMAG may be associated with structural abnormalities and may pose a diagnostic challenge especially in its rare facial segmental localization. The use of dermoscopy allowed us to find typical signs for IHMAG, thus avoiding the execution of invasive methods and ensuring the prompt suspicion of a syndrome in segmental neonatal cases.

Treatment of telangiectasias with a 595-nm pulsed dye laser following hemangioma involution: a retrospective analysis

Telangiectasias are the most frequent type of sequelae of infantile hemangiomas after involution. Few studies have reported the treatment of telangiectasias with 595-nm pulsed dye lasers. Therefore, the objective of this study was to assess the efficacy and safety of a 595-nm pulsed dye laser for treating residual telangiectasias following hemangioma involution. This is a retrospective case series that analyzes the medical records and reviews the charts of 22 patients who had undergone 595-nm pulsed dye laser treatment for residual telangiectasias. Pre- and post-treatment digital images were independently assessed, and the changes were scored to ascertain the efficacy of the treatment (0 = no change, 4 = complete improvement). Of the 22 patients, 59.1% experienced complete resolution of telangiectasias following treatment. No serious complications or side effects were reported. The observations indicate that the 595-nm pulsed dye laser is effective and safe for treating residual telangiectasias following hemangioma involution.

Comparison of efficacy and safety between oral propranolol combined with and without intralesional injection of lauromacrogol for infantile hemangioma

AIMS AND OBJECTIVES

The purpose of this study was to compare efficacy and side effects between oral propranolol combined with and without intralesional injection of lauromacrogol for infantile hemangioma (IH).

MATERIAL AND METHODS

This was a single center randomized controlled prospective study, all participants were firstly diagnosed with IH between August 2022 and January 2023 in our hospital and without any treatment before. Patients were randomized into two groups. PRO group: oral propranolol (2 mg/kg/day) continued for 6 months; PRO + LAU group: oral propranolol (2 mg/kg/day) for 6 months and intralesional injection of lauromacrogol for 2-4 times within 6 months. The dimensions, color, consistency, photographic documentation were well recorded based on Visual Analogue Scale (VAS) before and after starting treatment. According to the treatment response after 6 months, the results were classified into four levels: Grade 1, complete resolution achieved; Grade 2, with ≥50% reduction in size of IH; Grade 3, with <50% reduction in size of IH; Grade 4, no response or worsening of IH.

RESULTS

A total of 67 patients were involved in the study (17 boys, 50 girls; mean age, 3.6 months, range, 1.1-7.2 months) and randomized to receive oral propranolol combined with or without intralesional injection of lauromacrogol (29 in PRO group, 38 in PRO + LAU group). All patients completed treatment. Eleven patients (37.9%) in PRO group were in Grade 1, 14 patients (48.3%) in Grade 2, 4 patients (13.8%) in Grade 3, compared with these in PRO + LAU group, 11 patients (28.9%) in Grade 1, 24 patients (63.2%) in Grade 2, and 3 patients (7.9%) in Grade 3. No patient was in Grade 4, and no severe side effects were observed in both group. In PRO group, it takes an average of 17.1 ± 5.4 weeks from the start of treatment to cure, and in PRO + LAU group, the average time is 13.7 ± 4.9 weeks.

CONCLUSION

Oral propranolol with intralesional injection of lauromacrogol was a safety treatment strategy for IH. But it was not superior to oral propranolol in final cure rates (P = 0.45), moreover, it cannot certainly offer the benefits of shortening the duration of oral drug treatment (P = 0.24).

Congenital Vascular and Lymphatic Diseases

Over the past several centuries, the integration of contemporary medical techniques and innovative technologies, like genetic sequencing, have played a pivotal role in enhancing our comprehension of congenital vascular and lymphatic disorders. Nonetheless, the uncommon and complex characteristics of these disorders, especially considering their formation during the intrauterine stage, present significant obstacles in diagnosis and treatment. Here, we review the intricacies of these congenital abnormalities, offering an in-depth examination of key diagnostic approaches, genetic factors, and therapeutic methods.

How to Start on Dermatologic Ultrasound: Basic Anatomical Concepts, Guidelines, Technical Considerations, and Best Tips

Dermatologic ultrasound has grown exponentially during the last decades and has passed from the experimental phase to the routine daily practice in multiple countries. The performance of this imaging technique requires color Doppler ultrasound devices working with high-frequency probes, a trained operator on imaging and dermatologic conditions, and the performance of standardized protocols for obtaining the anatomical data properly. In this review, we analyze the ultrasonographic anatomy of the skin, hair, and nails, the technical requirements and considerations, the guidelines, and the recommended protocols, and provide the best tips for practicing this type of examination confidently.

Infantile Hemangioma in Infancy: A Case Study on the Natural Course and Therapeutic Management

Infantile hemangiomas (IHs) are common benign vascular tumors that affect infants. In this case report, we detail the natural course of an IH in an infant monitored over four months without medical intervention, illustrating the benign progression and potential for spontaneous stabilization of such lesions. The aim was to observe changes in the size and morphology of the hemangioma, alongside the infant's overall health and developmental milestones, through regular clinical assessments. This case presented a challenge as the patient's parents lacked English fluency, lacked healthcare access, and had low socioeconomic status. It highlights the importance of individualized patient care, advocating for careful observation and restraint in the application of pharmacological treatments when clinically unnecessary. The report contributes to existing pediatric dermatology knowledge by emphasizing the natural benign behavior of IH and the need for a balanced approach to treatment decisions, ensuring safe and favorable long-term outcomes for patients.

The prevalence, complications, and risk factors for infantile hemangioma: a systematic review and meta-analysis

The epidemiological landscape of infantile hemangioma (IH) has been extensively explored through diverse data sources; however, a scarcity of systematically pooled and quantified evidence from comprehensive global studies persists. In this meta-analysis, we systematically review available literature to elucidate the prevalence, distribution of lesions, complications, and risk factors associated with IH. A meticulous search encompassing the Cochrane Library, PubMed, Embase, and Web of Science identified 3206 records, of which 55 studies met the inclusion criteria. We found that the overall prevalence of IH is 2.8% [95% confidence interval (CI): 1.5-4.4%] (31,274,396 infants), and IH was located more frequently in the head and neck with a prevalence of 47.4% (95% CI: 39.5-55.4%). The overall prevalence of complications of IH is 24.3% (95% CI: 18.6-30.5%), ulceration is 16.0% (95% CI: 10.4-21.2%), bleeding is 5.6% (95% CI: 3.3-8.5%), visual impairment is 5.6% (95% CI: 3.0-8.9%), infection is 2.8% (95% CI: 1.5-4.8%), subglottic obstruction is 1.5% (95% CI: 0.5-3.0%), respectively. Through 27 studies, we have evaluated 35 factors encompassing perinatal factors, socioeconomic factors, maternal complications, drug factors, and antepartum procedures, and identified 18 risk factors that increase the prevalence of IH. These findings can greatly assist clinicians and family members in effectively evaluating the risk of IH, and determining whether pregnant women should undergo intensified monitoring or preventive measures.

A Review of the Current State and Future Directions for Management of Scalp and Facial Vascular Malformations

Vascular malformations are structural abnormalities that are thought to result from errors in vasculogenesis and angiogenesis during embryogenesis. Vascular malformations of the scalp present unique management challenges due to aesthetic and functional implications. This review examines the pathophysiology, clinical presentation, and management techniques for six common types of vascular malformations of the face and scalp : infantile hemangioma, capillary malformations, venous malformations, lymphatic malformations, arteriovenous malformations, and arteriovenous fistulas. These lesions range from common to rare, and have very different natural histories and management paradigms. There has been increasing understanding of the molecular pathways that are altered in association with these vascular lesions and these molecular targets may represent novel strategies of treating lesions that have historically been approached from a structural perspective only.