Complications of infantile hemangiomas

Low-dose sclerotherapy with lauromacrogol in the treatment of infantile hemangiomas: A retrospective analysis of 368 cases

BACKGROUND

Intralesional injection of lauromacrogol has proven to be an efficient treatment method for infantile hemangioma. This study aims to explore a novel injection therapy and evaluate its efficacy and complications.

METHODS

The medical records of 368 children with infantile hemangioma who received a lauromacrogol injection from January 2021 to April 2022 were retrospectively analyzed. All patients were reviewed every 4 weeks, and their condition was assessed according to symptoms and medical records. The patient's age, lesion type, location, size and thickness, lesion photographs, ultrasound, and complications were recorded.

RESULTS

Among the 368 infants who accept sclerotherapy with lauromacrogol, 226(61.4%)achieved excellent regression. In total, 108(29.4%)cases achieved good regression. 24(6.5%)achieved complete moderate regression. 10(2.7%)achieved poor regression. The reported incidence of adverse events was 4.9% and severe complications were not observed. Before and after three courses of treatment, the median vascular endothelial growth factor levels were 104.12 pg/ml and 28.982 pg/ml. There was a significant difference between the two groups (P=0.0043).

CONCLUSIONS

The results showed that this novel injection therapy a safe and effective treatment method. The therapy accelerated the regression of infantile hemangiomas without serious complications.

Palpable pediatric chest wall masses

Pediatric chest wall lesions are varied in etiology ranging from normal and benign to aggressive and malignant. When palpable, these lesions can alarm parents and clinicians alike. However, most palpable pediatric chest lesions are benign. Familiarity with the various entities, their incidences, and how to evaluate them with imaging is important for clinicians and radiologists. Here we review the most relevant palpable pediatric chest entities, their expected appearance and the specific clinical issues to aid in diagnosis and appropriate treatment.

Clinical characteristics of lip infantile haemangiomas and main risk factors for ulceration: an 8-year retrospective study of 69 Chinese infants

BACKGROUND

Infantile haemangiomas (IHs) involving the lip are of special concern because of the susceptibility of complications, including ulceration, obstruction and disfigurement. The available data for the relationship between their clinical characteristics and ulcerations are limited.

OBJECTIVES

To describe the clinical characteristics of lip IHs and to evaluate the main risk factors for ulceration.

METHODS

A retrospective study was designed that included infants with lip IHs during an 8-year period, the clinical data of participants were collected, and univariable and multivariable logistic models were used to determine the relationships between the clinical characteristics of lip IHs and ulcerations. Location, size and type were investigated as potential independent factors influencing the development of ulceration.

RESULTS

A total of 69 lip IHs were identified including 40 girls and 29 boys. Ulcerations were found in 37 (53.6%) lip IHs. Lip haemangiomas experiencing ulceration had a mean size (SD) of 3.49 (2.82) cm² compared with 1.08 (0.96) cm² for those without ulceration. Twenty-eight (52.8%) of the 53 localized haemangiomas and 9 (56.3%) of the 16 segmental haemangiomas experienced ulcerations. Univariable analyses of all investigated factors revealed significant associations of location and size with increased risk of ulceration, and these significant associations remained after adjusting for sex and age [OR 8.61 (95% CI, 2.24-33.13) and 2.62 (95% CI, 1.46-4.72), respectively]. The duration before ulceration was between 4 and 70 days after the occurrence of lip IHs, with a median of 28 (19.41) days. Most ulcers occurred within 45 days of IH occurrence.

CONCLUSIONS

Ulceration is a common complication of lip IHs at an earlier stage. A swollen with pale or bright crimson appearance of the lip IH surface could be an important signal of subsequent ulceration. Location of the IH on the lower lip and lip IH size are risk factors for the occurrence of ulceration.

Mono (2-ethylhexyl) phthalate (MEHP) triggers the proliferation of hemangioma-derived endothelial cells via YAP signals

Hemangioma (HA) is tumor formed by hyper-proliferation of vascular endothelial cells. However, the potential effects of mono-(2-ethylhexyl) phthalate (MEHP) on the progression of HA are not well illustrated. Our present study revealed that MEHP exposure can significantly increase the in vitro proliferation of hemangioma-derived endothelial cells (HemECs). MEHP treatment can activate yes-associated protein (YAP), a key effector of Hippo pathway, by inhibiting its phosphorylation. The dephosphorylation of YAP induced by MEHP can promote the nuclear accumulation of YAP. Knockdown of YAP or its inhibitor can block MEHP triggered cell proliferation. MEHP can increase the levels of precursor and mature mRNA of YAP in HemECs. As well, MEHP extended the half-life of YAP protein. Mechanistically, MEHP can decrease the phosphorylation of YAP via suppressing the activity of large tumor suppressor kinase 1/2 (LATS1/2) to inhibit it induced degradation of YAP. Further, MEHP increased the expression of interferon regulatory factor 1 (IRF1), which can bind to the promoter of YAP to initiate its transcription. Collectively, we revealed that Hippo-YAP signal is involved in MEHP-induced proliferation of HA cells.

Curcumin induces apoptosis and inhibits proliferation in infantile hemangioma endothelial cells via downregulation of MCL-1 and HIF-1α

BACKGROUND

Curcumin has been used as an alternative medicine for the treatment of infantile hemangiomas (IHs); however, the mechanism underlying the effectiveness of curcumin in IHs remains largely unclear.

METHODS

In this study, we isolated primary human hemangioma endothelial cells (HemECs) from fresh surgical specimens of 3 patients. We treated HemECs by curcumin and investigated the alterations in proliferative and apoptotic signaling pathways with cell counting kit-8, flow cytometry, western blotting, immunofluorescence, and real-time polymerase chain reaction.

RESULTS AND CONCLUSION

We found that curcumin potently inhibited proliferation in HemECs, achieving low-micromolar IC50 (the half maximal inhibitory concentration) value. We also observed that treatment with curcumin induced apoptosis in HemECs, as evidenced by positively Annexin-V-FITC staining, caspase-3 activation, and cleavage of poly(adenosine diphosphate-ribose) polymerase (PARP) in the treated cells. Moreover, we showed that curcumin suppressed the expression of antiapoptotic protein myeloid cell leukemia-1 (MCL-1), hypoxia-inducible factor 1α (HIF-1α), and vascular endothelial growth factor (VEGF).Altogether, our study suggests that the effectiveness of curcumin in IHs may be associated with its potent antiproliferative and apoptotic activities in HemECs.

Periocular dermatoses

The periocular area may be affected by infectious or noninfectious diseases such as inflammatory dermatoses, systemic disease, drug reactions, benign and malignant lesions, traumatic lesions, and esthetic complications. We present a review of the most common periocular dermatoses.

Analysis of factors affecting the therapeutic effect of propranolol for infantile haemangioma of the head and neck

Infantile haemangiomas (IHs) are the most common congenital vascular tumours of infancy. Propranolol has been demonstrated to be effective for IHs; however, the factors affecting its therapeutic effect remain unknown. We enrolled 169 infants with IHs of the head and neck region treated with oral propranolol at a dose of 2.0 mg/kg/day. We evaluated the therapeutic responses 6 months after treatment and the end of treatment, which were categorized into four grades. The type and location of the lesions and the infant age at treatment initiation were analysed. The clinical response rate (III + IV) was 91.72% at 6 months after treatment and 97.63% at the end of treatment. The average treatment duration was 9.99 (2–24) months. The group aged 4–6 months exhibited a greater therapeutic response rate (98.48%). The treatment duration was shorter (9.52 months) for mixed-type IHs. Better therapeutic responses were observed for IHs located around the parotid, periorbital, cheek, and neck regions and for multiple IH lesions. Our study indicated that propranolol is effective for IHs affecting the head and neck. The age at treatment initiation and the location of the lesions had a significant effect on the therapeutic response, whereas the lesion type might affect the treatment duration.