More proactive treatment needed for infantile haemangioma
We have seen more stories in the media concerning infantile haemangioma -recently it was reported that a small girl had an operation to remove a ‘clown nose' - a red-coloured tumour on her face. In that case, the specialist plastic surgeon was able to make a huge difference to the quality of life to that patient and her family.
But not every story ends this way.
Infantile haemangioma is the most common childhood tumour. It is benign and due to this, and the fact that it will involute (reduce in size) in time, it is usual for haemangioma to be left unless it causes functional problem. But - in addition to the psychological distress for the parents, and also the child when older - this practice has its drawbacks. Haemangioma that is left to proliferate uncontrollably can cause functional problems, such as the blocking of eyesight, and also ulceration, which is extremely painful.
Even when a haemangioma involutes, it can leave unsightly contour deformity, loose skin, poor skin texture, and residual telangiectasia (neurological condition). These cosmetic deformities can be difficult to correct in later age, especially if the haemangioma is at a cosmetic sensitive area. Surgeries will also invariably leave scars.
The gold standard for the treatment of rapidly proliferating haemangioma has been corticosteroid. Prolonged treatment is needed with high incidence of adverse results such as growth retardation, weight gain and adrenal suppression despite adequate weaning.
Propranolol has been used recently with impressive results. In our study, time to stop haemangioma proliferation was less than 48 hours in 74% of patients treated. All patients responded well, with very little side effects.
In view of the availability of propranolol treatment, the management of haemangioma should not be a wait and see approach. More proactive management is needed, and children with potentially aggressive haemangiomas should be identified, and referred to specialist centres that are familiar with the latest treatment at an early age. With effective treatment, most of the consequences of the haemangiomas and also the need to perform complicated corrective surgeries can be avoided.
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