Many hemangiomas, even with rapid growth, stay relatively small and cause no problems. Since they will eventually resolve, no treatment is needed. A significant minority of hemangiomas cause functional problems or threaten to leave permanent skin changes and require active treatment. Early in life, when hemangiomas have their greatest growth potential, it can be difficult to determine how big they will become, so your child may need to be seen in the clinic more often; as they get older this will be less often.
Reasons for treatment include: ulceration (breakdown of the skin), effect on important structures such as the eye, lip, or nose, psychosocial concerns, or when a hemangioma is so large or growing so rapidly that there is a real risk of leaving permanent scarring.
In deciding whether a hemangioma needs to be treated and with which medication to use, your child’s doctor needs to consider not only what the hemangioma looks like now, but what it might look like in a few years. Sometimes an early and active treatment approach is necessary. Other times it is wiser to adopt a “wait and see” approach. Like any decision in medical care, the potential benefits which might be gained from treatment must be carefully weighed against the risks of treatment.
The choice to use one of these various treatments involves the location of the hemangioma on the body, the age of the child, the growth stage of the hemangioma and parental preferences. There is no “one-size-fits-all” approach.
The American Academy of Pediatrics recently published clinical practice guidelines for the management of infantile hemangiomas: Krowchuk DP et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics Jan 2019;143(1) e20183475.
Right preauricular: This two-month-old boy presented with a large hemangioma of the lateral cheek region. He was treated with oral propranolol, and at 1 year of age (second photo), marked improvement is noted.
Please see the pages below for more detailed information about different hemangioma treatment options and considerations: