When to treat a hemangioma is a controversial area, but most experts would agree that those hemangiomas which interfere with breathing, feeding, or visual development should undergo aggressive treatment. There are also hemangiomas which grow so rapidly during the proliferative stage that they can present with painful ulceration and bleeding, requiring intervention. On occasion, hemangiomas can occur in the liver, where they can be so large and have such high flow that they put a strain on the heart. Finally, there is a rare variant called Kaposiform Hemangioendothelioma (KHE), which tends to occur over the trunk, thigh, or shoulder, and has an unusual diffuse reddish or purple color with thickening of the skin, resembling an inflammatory process. This lesion has a tendency to consume platelets from the blood (part of the normal clotting mechanism), which can in turn lead to bleeding complications.
If treatment is required for hemangiomas, it usually consists of local care (topical treatment) sometimes combined with systemic therapy. The mainstay of drug treatment for many years was oral steroids, which were effective but associated with a variety of side effects. A major breakthrough has been the use of the beta blocker drug Propranolol, a commonly used medication for cardiac conditions and high blood pressure in adults. It was recently discovered that this drug can dramatically accelerate the process of involution, used either as a topical cream or given orally. Studies have shown signs of shrinkage as early as the first month of treatment. This drug should be prescribed and monitored by specialists in the field.
Surgery for Hemangiomas
In the older medical literature, surgery was felt to play little role in the treatment of hemangiomas, due to their tendency to improve spontaneously over time. Surgery will clearly be required when a hemangioma affects an infant’s vision, breathing, or feeding. Over the past two decades there has been a resurgence of interest in the surgical removal of hemangiomas causing cosmetic deformity, particularly in the head and neck area. While it is true that small lesions may disappear over time leaving almost no trace, extensive lesions may leave behind pale, atrophic skin after involution, in some cases requiring plastic surgery to achieve an acceptable cosmetic appearance. Some plastic and head and neck surgeons feel that earlier surgical removal in these cases may be preferable, not only achieving an immediate improvement in appearance but also avoiding the psychosocial difficulties which may be encountered by children with a cosmetically disfiguring condition. These procedures should be performed by surgeons with specialized training and expertise in this field