Types of Infantile Hemangiomas

Infantile hemangiomas can be divided into superficial hemangiomas, subcutaneous (deep) hemangiomas, and mixed hemangiomas. All types of infantile hemangiomas are slightly warm to the touch.1

  • Superficial hemangiomas are often described as “strawberry marks” and appear as a bright red tumor with an irregular surface
    • Account for 50% to 60% of all infantile hemangiomas1
  • Subcutaneous or deep hemangiomas present as protruding tumors appearing under normal or bluish skin
    • Make up approximately 15% of all infantile hemangiomas1
  • Mixed or combined hemangiomas exhibit a combination of both superficial and subcutaneous characteristics
    • Account for 25% to 35% of infantile hemangiomas 1
types_of_hemangiomas

Superficial
hemangioma
Mixed
hemangioma
Mixed and ulcerated
hemangioma
Superficial
hemangioma
Nodular
hemangioma

 

Nodular Hemangioma

Morphological Subtypes of Infantile Hemangiomas

  • Focal (localized)1
    • Located on the bony prominences
    • 60% are located on the head and neck
  • Multifocal2
    • Multiple hemangiomas that can range in number
  • Segmental3
    • Cover 1 or more segments of the face and body
    • Can grow for up to 2 years

Most infantile hemangiomas are the nodular type, which are discrete, oval or round, and usually not associated with malformations. However, segmental hemangiomas are at a higher risk for complications like frequent ulceration. Segmental hemangiomas may have visceral involvement of internal organs, including the liver, gastrointestinal tract, cardiovascular system and brain.1

Segmental hemangiomas may also be associated with developmental abnormalities, including PHACE syndrome, PELVIS syndrome (also known as SACRAL syndrome).1

PHACE Syndrome

The acronym for PHACE stands for4:

  • Posterior fossa anomalies
  • Hemangioma
  • Arterial lesions
  • Cardiac and aortic abnormalities
  • Eye abnormalities

About 20% of segmental infantile hemangioma are associated with PHACE syndrome—88% of which are females.1

The acronym for PELVIS stands for1:

  • Perineal hemangiomas
  • External genital malformations
  • Lipomyelomeningocele
  • Vesico-renal anomalies
  • Imperforate anus
  • Skin tag

In a study of 11 patients with PELVIS syndrome, approximately 73% had digestive abnormalities and about 64% had urinary tract abnormalities.5



INDICATION
HEMANGEOLTM oral solution contains the beta-adrenergic blocker propranolol hydrochloride and is indicated for the treatment of proliferating infantile hemangioma requiring systemic therapy.

IMPORTANT SAFETY INFORMATION
HEMANGEOLTM is contraindicated in the following conditions:
  • Premature infants with corrected age <5 weeks
  • Infants weighing less than 2 kg
  • Known hypersensitivity to propranolol or any of the excipients
  • Asthma or history of bronchospasm
  • Heart rate <80 beats per minute, greater than first degree heart block, or decompensated heart failure
  • Blood pressure < 50/30 mmHg
  • Pheochromocytoma
HEMANGEOLTM prevents the response of endogenous catecholamines to correct hypoglycemia and masks the adrenergic warning signs of hypoglycemia, particularly tachycardia, palpitations and sweating.

HEMANGEOLTM can cause hypoglycemia in children, especially when they are not feeding regularly or are vomiting; withhold the dose under these conditions. Hypoglycemia may present in the form of seizures, lethargy, or coma. If a child has clinical signs of hypoglycemia, parents should discontinue HEMANGEOLTM and call their health care provider immediately or take the child to the emergency room.

Concomitant treatment with corticosteroids may increase the risks of hypoglycemia.

HEMANGEOLTM may cause or worsen bradycardia or hypotension. Monitor heart rate and blood pressure after treatment initiation or increase in dose. Discontinue treatment if severe (<80 beats per minute) or symptomatic bradycardia or hypotension (systolic blood pressure <50 mmHg) occurs.

HEMANGEOLTM can cause bronchospasm; do not use in patients with asthma or a history of bronchospasm. Interrupt treatment in the event of a lower respiratory tract infection associated with dyspnea and wheezing.

HEMANGEOLTM may worsen circulatory function in patients with congestive heart failure or increase the risk of stroke in PHACE syndrome patients with severe cerebrovascular anomalies. Investigate infants with large facial infantile hemangioma for potential arteriopathy associated with PHACE syndrome prior to HEMANGEOLTM therapy.

HEMANGEOLTM will interfere with epinephrine used to treat serious anaphylaxis.

The most frequently reported adverse reactions to HEMANGEOLTM (occurring ≥10% of patients) were sleep disorders, aggravated respiratory tract infections, diarrhea, and vomiting. Adverse reactions led to treatment discontinuation in fewer than 2% of treated patients.

The most common ( >3% more often on HEMANGEOLTM than on placebo) adverse reactions reported in the a total of 424 patients treated with HEMANGEOLTM 1.2 mg/kg/day or 3.4 mg/kg/day were sleep disorder (17.5%; 16.1%), bronchitis (8%; 13.4%), peripheral coldness (8%; 6.7%), agitation (8.5%; 4.5%), diarrhea (4.5%; 6.3%), somnolence (5%; 0.9%), nightmare (2%; 6.3%), irritability (5.5%; 1.3%), decreased appetite (2.5%; 3.6%), and abdominal pain (3.5%; 0.4%), respectively.

Adverse events such as cardiac disorders, urticaria, alopecia, hypogylcemia, and bradycardia occurred in less than 1%.

Safety and effectiveness for infantile hemangioma have not been established in pediatric patients greater than 1 year of age.

Please see Full Prescribing Information and Medication Guide .

Important Safety Information
References