Infantile hemangiomas are benign vascular tumors characterized by the proliferation of the endothelial cells.1 These lesions are rarely present at birth, but appear within the first few weeks of a child’s life.2
The evolution phases of infantile hemangioma growth include3-5:
The proliferation phase: rapid growth between 5 ½ and 7 ½ weeks of age that can last up to 6 months or longer3,4
The involution phase: stabilization then a slow, spontaneous regression over a span of 3 to 9 years5
The Cause of Infantile Hemangioma
It is not well understood what causes infantile hemangiomas. However, studies indicate that fetal hypoxic stress might trigger proliferation and abnormal blood vessel formation by stimulating endothelial progenitor cells.
Another hypothesis is that immature endothelial cells and pericytes, which coexist in the late stages of fetal development, may maintain persistent proliferation properties for a period of time after birth, leading to the development of infantile hemangioma.2
Diagnosis and Treatment
The first step in determining a diagnosis of infantile hemangioma is to perform a physical examination and discuss the infant’s medical history with their parent or caregiver. You will particularly want to know how long the infantile hemangioma has been present and if it has changed.7
Although you will often be able to diagnose infantile hemangiomas based on physical examination and medical history, imaging tests can also be helpful.7
You can use magnetic resonance imaging (MRI) to help differentiate infantile hemangiomas from other vascular lesions, such as arteriovenous or venous malformations. A skin biopsy can also be helpful in distinguishing unusual or atypical hemangiomas from other vascular lesions.8 GLUT-1 is an exclusive marker for infantile hemangioma and is used to distinguish infantile hemangiomas from other vascular lesions. Using glucose transporter 1 (GLUT-1) stain is helpful in evaluating tissue removed during a biopsy or excision. Proliferating and involuting infantile hemangiomas stain positively for GLUT-1, while other cutaneous vascular neoplasms, malformations, and normal cutaneous vasculature do not, making this stain very sensitive and specific for histologic confirmation of infantile hemangiomas.9
It may be important to refer to a specialist, such as a pediatric dermatologist, to help confirm a diagnosis and find the most appropriate treatment for your patient as soon as possible.2 Early treatment during the proliferation phase between 1 month to 5 months is important.3
Early Therapeutic Intervention During the Proliferation Phase of Hemangioma Growth Is Essential
Click here to learn more about the different types of infantile hemangiomas.