WAIKOLOA, HAWAII – The incidence of infantile hemangiomas has climbed steadily in recent decades in concert with rising rates of prematurity and low birth weight, Dr. Sheila Fallon Friedlander said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.
“We spend a lot of time talking about port wine stains, but guess what? They’re much less frequent than are infantile hemangiomas, which most studies agree have an incidence of about 5%, as compared to 0.1%-0.3% for port wine stains,” observed Dr. Friedlander, professor of dermatology and pediatrics at the University of California, San Diego.
Most of these lesions resolve over time, but some are disfiguring or even life threatening. With the availability of safe and effective therapies in the form of propranolol, nadolol, timolol, and lasers, it’s incumbent on physicians to make the diagnosis early and intervene in a timely manner when appropriate to avoid complications, the pediatric dermatologist emphasized.
She highlighted a recent population-based study of infants born in Olmsted County, Minn., during 1976-2010. The Mayo Clinic investigators found that the incidence of infantile hemangiomas climbed from 0.97 to 1.97 per 100 person-years over that time span. Meanwhile, the average gestational age at birth among babies with infantile hemangiomas in the county fell from 39.2 weeks to 38.3 weeks, and their average birth weight dropped from 3,383 g to 3,185 g (J Am Acad Dermatol. 2016;74:120-6).
Dr. Friedlander was senior investigator for a unique study, the first prospective U.S. study to track the incidence of infantile hemangiomas from birth through 9 months of age. The study included 578 mothers enrolled in pregnancy and their 594 offspring. All of the neonates were examined by a pediatric dermatologist within 48 hours after delivery, allowing for precise differentiation between infantile hemangiomas and other neonatal vascular lesions.
The incidence of infantile hemangiomas was 4.5%. The majority of the lesions occurred on the trunk or extremities. Of note, only one infantile hemangioma required intervention. Twenty percent of the infantile hemangiomas were small focal lesions with abortive or telangiectatic morphology that stopped growing by 3 months of age.
As in the Mayo Clinic study, Dr. Friedlander noted, the risk of infantile hemangioma in this San Diego–area study population increased with decreasing gestational age and weight. The incidence was 3.9% in term infants, 7.4% in premature infants, and 14.3% in those who were very premature. Similarly, infantile hemangiomas occurred in 4% of normal-birth-weight babies but in 16.6% of those who were very low birth weight (Br J Dermatol. 2014;170:907-13).
Abnormalities of placental perfusion occurred in nearly 35% of pregnancies that produced babies with infantile hemangiomas, a rate twice that seen in pregnancies not associated with a subsequent infantile hemangioma. This and other evidence points to hypoxia as a key factor in precipitating the development of infantile hemangiomas.
“We believe that these lesions are related to embolization of tissue, perhaps placental, or hypoxia in utero,” Dr. Friedlander said. “Extreme prematurity, low birth weight, Caucasian race, placental anomalies, increased maternal age, use of fertility drugs – these are all things that will up your ante for having a child with an infantile hemangioma.”
She reported receiving grant/research support from Merz and Valeant Pharmaceuticals, and serving as a consultant for Sandoz.
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