Prevalence and Clinical Characteristics in Patients with Complicated Infantile Hemangioma: A Single Center Study

Abstract

Background: Infantile hemangiomas (IHs) are the most prevalent benign vascular tumors in children. While most IHs are uncomplicated, a minority may develop complications, including ulceration, disfigurement, and visual disturbance which can lead to significant morbidities.

Objectives: To analyze the prevalence of complicated IHs, identify the clinical characteristics, management, and treatment responses in patients with complicated IHs

Methods: Retrospective, descriptive study was conducted at the Pediatric Dermatology Clinic of Queen Sirikit National Institute of Child Health, encompassing pediatric patients under 1 year old diagnosed with IH from January 2019 to December 2023.

Results: Among 300 IH patients, the complicated IHs were found in 54 cases (18.0%). The mean age was 4.2±2.59 months. The complications included ulceration (n=39; 72.2%), disfigurement (n=9; 16.7%), visual disturbance (n=1; 1.9%), hepatic hemangioma (n=5; 9.3%), subglottic hemangioma (n=1; 1.9%), and PELVIS syndrome (n=1; 1.9%). Ulceration was the most common complication, mostly located in the diaper area (n=11; 28.2%; P <0.001) and lips (n=10; 25.6%; P 0.004), with larger IHs (≥ 5 cm) were more prone to ulcerate than smaller IHs (P <0.001). Most of the patients underwent multiple treatment modalities including oral propranolol (n=54; 100%; mean duration 10.8 months), topical timolol (n=5; 9.3%), antibiotics (n=22; 40.7%), and pulsed dye laser used for ulcerated IHs (n=28; 51.9%). All complicated IH patients regressed after treatments.

Conclusion: Ulceration represented the most frequent complication, predominantly observed in the diaper region, lip, and in lesions exceeding 5 cm in size. Understanding the timing of onset, clinical characteristics, and treatments can serve as valuable guidance for early intervention to prevent complications.