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. Systemic Involvement
Disseminated neonatal haemangiomatosis

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

30. Thank you