Skin hemangioma treatments - Hemangioma removal

Home > What is hemangioma? > Skin hemangioma - treatment and removal

Early removal of skin hemangioma with combination or multiple treatment options helps in reducing the risks of scars, cosmetic blemishes, facial disfigurement and other serious complications.

There are many treatment options available for removal of hemangioma on skin. Depending upon the need, individualized treatment plans can be opted for each patient as well as each lesion.

Medical observation and evaluation of hemangioma

     There is a drastic change from the traditional approach to hemangioma relief, like ‘leave it alone it will go away’, to having a close medical observation, frequent evaluation of the lesions and early intervention and removal, if necessary, to avoid future complications, life-risks and cosmetic skin disfigurements.

     Only about 2% of infantile skin hemangiomas are actually visible at birth. Tollefson M.M and Frieden I.J in their study "Early growth of infantile hemangiomas: what parents' photographs tell us." concluded that the precursors were present at birth in 65% of patients. They found that IH growth was nonlinear; most rapid growth occurred between 5.5 and 7.5 weeks of age and that the most rapid hemangioma growth occurred before 8 weeks of age. Megha M. Tollefson and colleagues found that the mean "optimal age for referral" was 4 weeks of age.

     They suggest "a need for a paradigm shift in the timing of referral and initiation of treatment of high-risk IH so that therapy can be initiated before or early in the course of most rapid growth, rather than after it is already completed".

Hemangioma treatment and removal with medications

     Steriods are the first-line medications for the treatment and removal of skin hemangiomas. As oral systemic corticosteroids slow down or stop the growth of lesions, they are successfully used for treatment and removal of rapidly proliferating lesions. By blocking the rapid proliferation phase, the involution phase may get advanced. This helps in buying time for taking up other treatment and removal strategies.

     Some infants may develop side effects for steroids like immunosuppression, gastrointestinal upset or retarded growth and hence close monitoring is necessary during the healing.

     Intra-lesional injections of corticosteroids into localized, small or deep skin hemangiomas in problematic areas like eye lids and ear canals have been found to be useful. Topical corticosteroids are useful in removal of small superficial strawberry birthmarks on skin.

     Propranolol, a sympatholytic non-selective beta blocker, has been used for many years in treatment of hypertension, anxiety and panic. In recent studies it was found that propranolol can be used for treatment of severe infantile hemangiomas. Further controlled trials have to be conducted for proving its efficacy for therapetic use. Many adverse drug reactions (ADRs) like  nausea, diarrhea, bronchospasm, hypotension, heart failure and dizziness are associated with the use of propranolol.

     Vincristine, a mitotic inhibitor used in cancer chemotherapy, has been successfully used for treatment and removal of lesions, which are problematic and are affecting vital functions. Vincristine is delivered via intravenous infusion. As vincristine has main side-effects like peripheral neuropathy, hyponatremia, ascending paralysis, and spinal nerve demyelination, it has to used with great caution.

     Interferon-alpha injections have been used successfully for treatment and removal of lesions affecting vital functions. Interferon-alpha also has many  adverse effects like flu-like symptoms, neutropenia, immunosuppression and convulsions.

Treatment and removal with surgical excision

     Hemangioma lesions are operable both during proliferation and involution phases. However the removal of proliferating skin hemangiomas by surgical excision is potentially risky due to possibility of hemorrhage and damage to vital tissues. This procedure has to be performed only by well trained surgeons. This type of early intervention and removal can preserve vital functions and reduce the psychosocial impacts associated with cosmetic disfigurement during childhood.

     Surgical excision and removal of loose skin or dilated bundles of blood vessels remaining after the involution of hemangioma is recommended to improve the esthetic appearance of the child. Generally lesions which regress slowly are likely to leave atrophic and hypertrophic scars, thinning of the skin or structural irregularities of the skin. Removal of these skin blemishes may require corrective surgery.

Skin hemangioma treatment and removal with lasers

     Among the various laser treatments available pulsed dye laser (PDL) with a dynamic cooling device is the first-line laser treatment for removal of these superficial skin lesions. Pulsed dye laser is very helpful in case of ulcerated skin lesions and telangiectasia (broken blood vessels) after regression.
   
     For removal of lesions involving deep hemangiomas of oral cavity, larynx, pharynx or airway, Nd:YAG laser can be used. Nd:YAG (neodymium-doped yttrium aluminum garnet; Nd:Y₃A_l5O₁₂) is a crystal that is used as an active laser medium for solid-state lasers. Potassium titanyl phosphate (KTiOPO₄) or KTP laser and carbon dioxide lasers are used for treatment and removal of airway hemangiomas.

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Skin hemangioma - treatment and removal.

References:
1. Tollefson MM, Frieden IJ. Early growth of infantile hemangiomas: what parents' photographs tell us. Pediatrics. 2012 Aug;130(2):e314-20. Epub 2012 Jul 23.
2. Haggstrom AN et al. (September 2006). Pediatrics 118 (3): 882–7. doi:10.1542/peds.2006-0413. PMID 16950977. "Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment".

What is a Hemangioma? What are the Causes of Hemangioma?

Home > Reddened skin > What is a Hemangioma? Causes of Hemangioma.

Hemangioma is a benign tumor formed by the abnormal growth and buildup of blood vessels. The cause of hemangioma is unknown.

Hemangioma usually appears on the skin, especially on the head, face and neck. It may form in the top skin layers (capillary) or deeper in the skin (cavernous). It may also appear on the internal organs like liver, spine and vertebrae. The term hemangioma comes from Greek words meaning "blood-vessel-tumor".

These lesions are the most common benign tumors in children. These lesions may be present at birth as birth marks having faint reddened areas or develop after birth in the early months. Usually these tumors grow rapidly for about twelve months. Then there is a resting phase with little change in appearance for another twelve months. Then the involution phase starts and causes the lesions to diminish in size and disappear in ten years. In rare cases it may persist beyond ten years.

Hemangiomas and vascular malformations

     Earlier the term hemangioma was used to denote a variety of vascular lesions of infancy and childhood. Mulliken JB. and Glowacki J. categorized these conditions into  hemangiomas and vascular malformations. Hemangiomas have a proliferating phase characterized by endothelial hyperplasia which causes rapid growth of tumor. Then there is an involution phase with histological fibrosis and fat deposition followed by a regression phase. Under the microscope, these lesions appear as aggregates of closely packed capillaries filled with blood having endothelial lining.

     Vascular malformations are usually seen at birth and they grow proportionately with the child-growth. Vascular malformations consist of abnormal arteries, veins and capillaries and are essentially permanent. This categorization helps in deciding on the type of treatment required, if any.

Causes of hemangioma

     The exact cause of this benign tumor is unknown. Several views and hypotheses have been suggested as possible causes of these lesions. Several studies suggested a role for the estrogen hormone for their development. A study suggested that higher levels of estrogen circulating in the infant blood coupled with the localized tissue hypoxia may be a cause or a triggering factor for these lesions.

     Another study hypothesized that embolisms of maternal placenta on to dermis of fetus may be the cause of hemangioma. However this view was contradicted by the DNA studies of the mother and lesion tissue. More research is required to know the cause of the explosive rate of growth of these tumors.

     Hemangioma is more prevalent in Caucasian infants than in Asian infants. It is rarely found in African-American infants. About 5% of Caucasian infants are born with these lesions. The cause of this ethnic variation is unknown. The low amount of melanocytes present in fairer skin may be a cause for the development of these tumors. Premature infants and small infants are more prone to have or develop these tumors. Further, when compared to males more number of female infants are affected.

     These tumors have potential for complications and permanent scarring. The risks involved include visual obstruction, breathing obstruction, ear canal obstruction facial disfigurement or bleeding ulceration. The tumors of the internal organs can lead to pain, impaired organ function or failure. When the tumor is very large it may create excess load and stress on the heart. The presence of lesions may have a psychological impact on the child and cause emotional distress and behavioral problems. Hence the presence of hemangioma in infants requires medical advice and early treatment.

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4. Acute Urticaria (hives).
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Current Skin Care topic:
What is a Hemangioma? Causes of Hemangioma.

References:
 1. Haggstrom AN et al. (September 2006). Pediatrics 118 (3): 882–7. doi:10.1542/peds.2006-0413. PMID 16950977. "Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment".