Clinical scenario | Anticipated complications | Suggested investigation | Treatment considerations |
---|---|---|---|
Ulceration | Pain, scarring; difficulty feeding; disfigurement | Usually not required | Saline/peroxide soaks |
Liberal use of emollients | |||
Topical metronidazole | |||
Lidocaine 5% ointment | |||
Becaplermin gel | |||
Pulsed dye laser | |||
Propranolol if severe | |||
Potentially disfiguring haemangioma Periorbital / Nasal tip / Exophytic | Ocular complications: strabismus/amblyopia; fibrofatty residuum; anetoderma; telangiectasias | Ophthalmology evaluation in periocular infantile haemangiomas | Periocular or nasal tip location |
Topical steroids | |||
Intralesional steroids | |||
Topical timolol or other topical therapy | |||
Oral propranolol or steroids | |||
Exophytic haemangiomas | |||
Intralesional steroids | |||
Early excision | |||
Segmental facial haemangioma (particularly S1 or S3 distribution) | PHACE syndrome: cerebrovascular, cardiac, eye anomalies | Echocardiogram; MRI/MRA of brain and neck; ophthalmology evaluation | Multi-disciplinary approach; systemic steroids; propranolol or other β blocker |
Lumbosacral or perineal haemangioma | Tethered spinal cord; lipomyel- omenigocele; genitourinary anomalies | Ultrasound of lumbar spine if neonate; MRI spine±pelvis | Referral to neurosurgery or urology if indicated; release of tethered cord |
Airway haemangioma | Life-threatening airway obstruction | Physical exam (S3 involvement, stridor/noisy breathing); referral to ENT for direct laryngoscopy | Propranolol or other β blockers; systemic steroids |
Multifocal infantile haemangiomas | Symptomatic hepatic involvement; hypothyroidism | Hepatic ultrasound with Doppler assessment of flow; thyroid function studies | Propranolol; systemic steroids; thyroid hormone replacement; if severe or abdominal compartment syndrome not responding to other systemic treatments: vincristine, embolisation or liver transplantation |
ENT, ear, nose and throat; MRA, MR angiogram.