BOSTON – Approximately half of all central facial hemangiomas in infants result in significant scarring – an outcome that could potentially be prevented with earlier recognition and treatment, according to Dr. Ilona Frieden.
The challenge, however, lies in determining which infantile lesions are a high risk, and which are unlikely to pose a problem, she explained at the American Academy of Dermatology’s Summer Academy Meeting.
Dr. Ilona Frieden
In a recent study of early infantile hemangioma growth based on a review of parental photographs, Dr. Frieden, a clinical professor of dermatology and pediatrics at the University of California, San Francisco, and colleagues found that lesion growth peaked between 5.5 and 7.5 weeks of age (Pediatrics 2012;130:e314-20).
This is "much earlier than we had previously believed," she said. "Unfortunately, referral to a specialist for evaluation and the initiation of treatment typically occurs later than this."
Because most hemangiomas eventually shrink, "pediatricians often recommend waiting for them to go away," Dr. Frieden said. "There is a historic dogma that because hemangiomas are benign, we don’t have to be too worried about them. Unfortunately pediatricians don’t always understand enough about hemangiomas to be able to pick out the bad actors from the ones that are benign." And while dermatologists do have the necessary understanding, it is estimated that 4%-10% of infants develop a hemangioma in the first weeks after birth. "Obviously we are never going to be able to see all of them," she said.
To bridge the divide, Dr. Frieden said that a paradigm shift in the timing of referral and management of high-risk infantile hemangiomas – "ideally by 4 weeks of age to prevent permanent skin changes or growth complications" – is warranted.
Clinical dermatology practices should have mechanisms in place to accommodate urgent evaluations of infants with high-risk hemangiomas, she said. Some of the larger, integrated practices, such as Kaiser Permanente in Northern California, are beginning to do this by establishing photo triage capabilities, where an expert reviews photos of hemangiomas.
Dr. Frieden disclosed having no financial conflicts of interest.