Treatment

Most cases require no treatment and are managed expectantly.

When systemic treatment is indicated after specialist review, propranolol is the drug of choice (1):

• treatment with propranolol can usually be initiated on an outpatient basis by a specialist, without monitoring of heart rate or blood pressure for term infants older than 4 weeks with no clinically significant comorbidities, of normal birth weight, established feeds, and appropriate weight gain
• topical beta blockers may be considered for small superficial lesions
• oral corticosteroids
  • was standard of care for infantile haemangiomas before propranolol was widely available, and can be used if propranolol is contraindicated or as an adjunct to propranolol in complex lesions where early response is needed
  • surgery or pulsed dye laser has also been used as first line therapy

Reference:

• 1. Surlis T, De Sa Reilly H, Sadlier M, Nelson J. Infantile haemangiomas BMJ 2022; 378 :e068734 doi:10.1136/bmj-2021-068734
• 2. Pope E et al. Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial. Pediatrics 2007;119:e1239-e1247
• 3. Mulliken JB et al. Case 13-2004. A newborn girl with a large cutaneous lesion, thrombocytopenia, and anemia. N Engl J Med. 2004;350(17):1764-75.