Skin disease in a child: Haemangioma Flashcards
Define haemangioma.
Benign vascular lesions. Typically, they appear during the first weeks of life as blue or pink macules or patches. They subsequently enter a proliferative phase and become elevated above the surrounding skin surfaces. This growth pattern distinguishes haemangiomas from other vascular lesions.
What are vascular tumours in the International Society for the study of Vascular Anomalies classification?
Infantile haemangioma
Congenital haemangioma
Pyogenic granuloma
Kaposiform haemangioendothelioma
What are vascular malformations in the International Society for the study of Vascular Anomalies classification?
Capillary malformation (“port-wine” stain)
Venous malformation
Lymphatic malformation
Arteriovenous malformation
Explain the aetiology of haemangioma.
The aetiology of haemangioma is poorly understood. Both intrinsic and extrinsic mechanisms have been proposed.
What are risk factors for haemangioma?
Low birth weight
Birth prematurity
White ethnicity
Female gender
Maternal multiple gestation
Advanced maternal age
What is the pathophysiology of haemangiomas?
Infantile haemangioma may originate from the embryonic mesoderm, a pericyte or endothelial precursor, or localised angioblasts.
According to the intrinsic theory, infantile haemangioma originates from vasculogeneis.
Extrinsic theory suggests that external environmental factors provide an environment favourable for the development of infantile haemangioma. Proposed stimulants include hypoxia, local growth factors, cytokines, and oestrogens.
Summarise the epidemiology of haemangiomas.
Haemangiomas are common among vascular tumours. The incidence during the first year of life is typically reported as 10-12% of all vascular tumours.
What are the signs and symptoms of haemangiomas?
Presence of variable risk factors, pink/red/blue colour, rapid growth, variable compressibility, flat or nodular character.
Common: Warmth, ulceration/bleeding/islands of normal skin.
What are appropriate investigations for haemangiomas?
Doppler ultrasound of haemangioma used to distinguish infantile haemangioma from vascular malformations (e.g venous malformations, AV malformations, lymphatic malformations).
Consider: MRI of haemangioma, biopsy of lesion.
What is the management of haemangiomas?
Aysmptomatic: Education and reassurance.
If functional impairment or cosmetic difiguration: 1st line- Beta-blocker and/or corticosteroid with surgical excision as the adjunct.
If ulceration: Add astringents and barrier protection, adjunct: Topical antibiotic, topical becaplermin, analgesia, pulsed dye laser
What are complications associated with haemangioma?
Propranolol-related adverse effects, cosmetic disfigurement, corticosteroid-induced Cushing’s syndrome, corticosteroidinduced adrenal suppression, treatment-related vision loss, lesional ulceration, airway obstruction, cardiac failure.
What is the prognosis of haemangiomas?
For most patients, a haemangioma follows a predictable, uncomplicated pattern of growth followed by slow involution lasting 1 to 8 years.
Intense proliferative growth is complete by 5 months of age in 80% of patients with haemangioma.
By 9 months of age, overall growth is almost always complete.
