Management of Cutaneous Hemangiomas in Pediatric Patients

Cutaneous hemangiomas (CHs) are common benign vascular tumors of childhood. Clinically, they are characterized by a typical evolution profile, consisting of a rapid proliferation during the first year of life and slow involution that usually is completed by 5 to 10 years of age. In most cases, no treatment is necessary. However, when CHs are located in areas at risk for functional complications; are of considerable size; or repeatedly undergo bleeding, ulceration, or superinfection, a prompt and adequate treatment approach is required. First-line approaches include topical, intralesional, and systemic corticosteroids. Second-line options include interferon alfa-2a and -2b, laser therapy, and surgical therapy. Third-line approaches include cytotoxins, embolization, and angiogenesis inhibitors. Other therapies and procedural approaches including intermittent pneumatic and continuous compression; cryosurgery; radiotherapy; implantation of copper needles; sclerotherapy; electrocautery; electroacupuncture; imiquimod cream 5%; and prospective agents, such as OXi4503 (diphosphate prodrug of combretastatin A1) and cidofovir, are discussed. Treatment options for ulcerated CHs also are described.