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Medical Management of Haemangiomas

Medical Management of Haemangiomas. Dr Anne Halbert Department of Dermatology Princess Margaret Hospital. Haemangioma. The most common benign proliferative tumour of infancy One or more lesions can be found in 10-12% of infants aged 12 months The vast majority require no treatment.

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Medical Management of Haemangiomas

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  1. Medical Management of Haemangiomas Dr Anne Halbert Department of Dermatology Princess Margaret Hospital

  2. Haemangioma • The most common benign proliferative tumour of infancy • One or more lesions can be found in 10-12% of infants aged 12 months • The vast majority require no treatment

  3. Potential Complications Ulceration • The most common complication (15%) • Particularly prevalent in the nappy area and on the lip • Painful • Inevitably heal with scarring

  4. Ulcerated Haemangioma

  5. Complications of Haemangioma Functional obstruction • Eye • Astigmatic and refractive errors • Amblyopia and blindness • Nose • Airway

  6. Visual Obstruction

  7. Visual Obstruction

  8. Airway Compromise • Nasal distortion

  9. Airway Compromise

  10. Disseminated neonatal haemangiomatosis Systemic Involvement

  11. DNH

  12. DNH haemangiomas Thalamic lesion

  13. DNH • Very high mortality • Liver is the most commonly affected organ • Risk of high output congestive cardiac failure • Babies with numerous miliary haemangiomas need to be screened early and often for the development of visceral lesions

  14. Systemic Involvement Contiguous Extension

  15. Contiguous Extension aorta haemangioma Spinal cord haemangioma

  16. PHACE Syndrome P posterior fossa abnormalities H haemangioma A arterial abnormalities C cardiac defects E eye abnormalities

  17. Kasabach Merritt Syndrome • Usually a rapidly proliferating haemangioendothelioma • Platelet consumption early in life • Develop disseminated intravascular coagulation • High mortality rate • Beware a bruised appearance

  18. Kasabach Merritt Syndrome

  19. Potentially Permanently Disfiguring Haemangiomas • Large facial haemangiomas which may involute leaving altered skin texture and fibrofatty residuum • Haemangiomas distorting cartilage of nose or ear

  20. Post Involution

  21. Treatments Pulsed Dye Laser • Treatment of choice for ulcerated haemangiomas • May help switch off proliferative phase in very superficial lesions • Useful after involution, to clear away residual telangiectasia

  22. Treatments Corticosteroids • Potent topical steroids • Intralesional steroids • Useful for localized facial lesions • 20-40 mg/ml triamcinolone or Celestone Chronodose repeated 6-8 weekly • Technically difficult – risk of ulceration • Avoid around the eye (central retinal artery occlusion)

  23. Treatments Systemic Corticosteroids • First line treatment for the prevention of functional obstruction, visceral haemangiomatosis and K-M syndrome • 2 mg/kg/d as a single morning dose • Usually well tolerated • Treatment lasts 8-12 weeks

  24. Pre-systemic steroids After 2 wks of steroids

  25. Systemic Corticosteroids Adverse Effects • Initial irritability in 75% • Reflux • Temporary reduction in growth (no permanent effect) • HPA axis suppression • Delay vaccinations

  26. Systemic Treatments Interferon Alpha • Used in conjunction with systemic steroids for life threatening complications • 1 million units/m2 /day SC initially • Anti-angiogenesis; also speeds involution • Adverse effects include neutropenia, abnormal LFTs and spastic diplegia

  27. Systemic Treatments Vincristine Cyclophosphamide

  28. Thank you

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