Transcript Haemangiomas and Medical Management

Medical Management
of Haemangiomas
Dr Anne Halbert
Department of Dermatology
Princess Margaret Hospital
Haemangioma
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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
Potential Complications
Ulceration
 The most common
complication (15%)
 Particularly prevalent in
the nappy area and on
the lip
 Painful
 Inevitably heal with
scarring
Ulcerated Haemangioma
Complications of Haemangioma
Functional obstruction
 Eye
Astigmatic and refractive errors
 Amblyopia and blindness
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Nose
Airway
Visual Obstruction
Visual Obstruction
Airway Compromise
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Nasal distortion
Airway Compromise
Systemic Involvement
Disseminated neonatal haemangiomatosis
DNH
DNH
haemangiomas
Thalamic
lesion
DNH
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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
Systemic Involvement
Contiguous Extension
Contiguous Extension
aorta
haemangioma
Spinal cord
haemangioma
PHACE Syndrome
P posterior fossa
abnormalities
H haemangioma
A arterial abnormalities
C cardiac defects
E eye abnormalities
Kasabach Merritt Syndrome
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Usually a rapidly proliferating
haemangioendothelioma
Platelet consumption early in life
Develop disseminated intravascular coagulation
High mortality rate
Beware a bruised appearance
Kasabach Merritt Syndrome
Potentially Permanently Disfiguring
Haemangiomas
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Large facial haemangiomas which may involute
leaving altered skin texture and fibrofatty
residuum
Haemangiomas distorting cartilage of nose or
ear
Post Involution
Treatments
Pulsed Dye Laser
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Treatment of choice for ulcerated
haemangiomas
May help switch off proliferative phase in very
superficial lesions
Useful after involution, to clear away residual
telangiectasia
Treatments
Corticosteroids
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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)
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Treatments
Systemic Corticosteroids
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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
Pre-systemic steroids
After 2 wks of steroids
Systemic Corticosteroids
Adverse Effects
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Initial irritability in 75%
Reflux
Temporary reduction in growth (no permanent
effect)
HPA axis suppression
Delay vaccinations
Systemic Treatments
Interferon Alpha
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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
Systemic Treatments
Vincristine
Cyclophosphamide
Thank you