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Introduction: Infantile hemangioma (IH) is the most common benign tumor in infancy. Oral corticosteroids (OCs) still have an important role in the treatment of complex IH. In the present study, we provide our experience of oral propranolol + OCs treatment for IH. Materials and Methods: This was a retrospective cohort study of 26 IHs treated with propranolol, either alone or in combination with OCs, at the National Institute of Pediatrics, Mexico. Information on clinical and demographic data was collected. Data were summarized as mean (standard deviation) or median (minimum, maximum) or frequencies and proportions as needed. Comparative analysis between the group only treated with propranolol and the group treated with propranolol plus OCs was performed with Fisher's exact test or Mann-Whitney C-tests. Results: All of our patients had a positive response to treatment. The comparison between both groups showed that the maximum and mean propranolol doses were significantly lower in the group of patients receiving combined treatment. Conclusions: Our findings support that the use of propranolol plus corticosteroids in IH allows the use of lower doses of both drugs for longer periods with less risk of adverse effects and fewer or no relapses. [ABSTRACT FROM AUTHOR]

Introduction: The quality of life of both the child and their caretakers has been noted to be adversely affected by visible birthmarks and resultant scarring, particularly in areas that cannot be easily covered. With the current knowledge about the uncertain trend in the progression of infantile hemangiomas (IH), the risks associated with it, and the availability of safe and effective treatment options available, a question arises, that should all hemangiomas be treated? A national survey was conducted to determine dermatologists' opinions throughout the country followed by the analysis and literature review. Methodology: An anonymous questionnaire of 10 questions was shared among dermatologists of the country using a link distributed through the electronic media. The data submitted anonymously by the responders were analyzed after due permission for its use for research and publication was received. Results: A total of 91 clinicians completed the questionnaires. 54.95% of the respondents answered that they would wait and watch in the majority of the cases presenting to them. 83.52% of the responders chose topical timolol as the most common medical treatment modality. 33.71% of the responders reported the resolution of IH in more than 75% of their patients and fibrofatty residue was the most common sequelae reported post the involuntary stage. 65.56% of the responders answered no to the question − "Should all hemangiomas be treated?" Conclusion: Clinical experience backed with research has proved the efficacy of beta-blockers in the resolution of IH beyond doubt. The need to identify, evaluate, and initiate timely treatment is required to avoid missing the window of opportunity to optimize the outcomes. [ABSTRACT FROM AUTHOR]

This article, titled "β‑blockers in Management of Infantile Hemangiomas," discusses the use of oral β‑blocker therapy in the treatment of infantile hemangiomas (IHs). The case study presented in the article describes the successful treatment of an 18-month-old girl with an IH using oral atenolol. IHs are common vascular tumors in infants that typically follow a course of rapid proliferation followed by gradual involution. β‑blockers, such as atenolol, are the current standard of care for IHs and work by vasoconstriction and triggering apoptosis. The article emphasizes the importance of early initiation of therapy and highlights the efficacy of atenolol even in late presentations. [Extracted from the article]

Computed tomography scan of the head was normal, but magnetic resonance imaging (MRI) brain showed multiple scalp hemangiomas, the largest being in the right posterior parietal region (size 16 mm × 6 mm), while underlying skull vault appears normal [Figure 3]. The red-colored raised lesion initially appeared in multiple mustard size, round, firm lesions, which progressed to almost pea-sized pedunculated lesions in 2-5 days and bled on touch/slightest trauma. There was the presence of a raised solid skin-colored lesion of size 2 cm and rubbery consistency over the right posterior parietal scalp diagnosed clinically as infantile hemangioma. [Extracted from the article]

Introduction: With the advent of topical timolol, there has been a tremendous change in the management of infantile hemangiomas. Aims: The aim of the study was to evaluate the treatment response with topical 0.5% timolol drops in 20 children of infantile hemangiomas. Methods: The response to treatment was seen as regression of growth or flattening of lesion or lightening of the surface. Timolol drops 0.5% were applied over the hemangiomas and three drops were applied twice daily. Results: Head-and-neck involvement was seen in 40% of the infants, the trunk was involved in 30% of the infants, the limbs were involved in 25% of the infants, and the genitalia were involved in 5% of the infants. Response to treatment with timolol was excellent in 60% of the infants, very good in 20% of the infants, good in 15% of the infants, average in 5% of the infants, and none of the infants showed poor response. Regarding the side effects of topical timolol, sleep disturbances and poor feeding were seen in 5% of the infants. Discussion: Timolol is used for hemangiomas that do not involute spontaneously or for infected or ulcerated hemangiomas or those hemangiomas in which there is a risk of scarring, disfigurement, or impairment of vital structures.

Objective: To study dermoscopic (DS) patterns of various congenital dermatologic conditions affecting pediatric age group. Background: DS helps to fill gap between histopathology and gross examination, especially in children as they are noncooperative for invasive procedure. It also helps in early detection of malignant change. Methodology: One hundred and forty-nine children with congenital dermatoses were enrolled in a study conducted from August 2017 to January 2018 in dermatology outpatient department (OPD). After proper history and examination, DS images were captured using DermLite DL IV and stored for analysis. Results: One hundred and forty-nine DS images of 22 congenital dermatoses were studied including 80 males and 69 females. Homogenous pattern (80%) was the most common pattern observed in melanocytic nevi (26). Mongolian spots (25) had greenish hue (100%) on DS. Hemangioma (13) and port wine stains (5) showed cherry red vacuoles and red dots against a pink background, respectively. Criss-cross, rhomboid, and lamellate pattern of scales were observed in DS of congenital ichthyosis (8). We also analyzed DS features of bullous and perforating disorders, syndromes, few rare miscellaneous conditions, and hair disorders. Conclusions: DS is a non-invasive diagnostic tool which enables visualization of deeper structures of the skin which are not seen with naked eyes. Melanocytic nevus, if disorganized, indicates increased risk for melanoma in situ. Pattern of scales on DS helps to classify ichthyosis. Regular brown dots suggest wart-like infection in epidermodysplasia verruciformis. DS of monilethrix and short anagen syndrome helps in differentiating from other hairs shaft disorders. Although time consuming, DS is easy to perform, especially in children and it aids to confirm the diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: With the advent of topical timolol, there has been a tremendous change in the management of infantile hemangiomas. Aims: The aim of the study was to evaluate the treatment response with topical 0.5% timolol drops in 20 children of infantile hemangiomas. Methods: The response to treatment was seen as regression of growth or flattening of lesion or lightening of the surface. Timolol drops 0.5% were applied over the hemangiomas and three drops were applied twice daily. Results: Head-and-neck involvement was seen in 40% of the infants, the trunk was involved in 30% of the infants, the limbs were involved in 25% of the infants, and the genitalia were involved in 5% of the infants. Response to treatment with timolol was excellent in 60% of the infants, very good in 20% of the infants, good in 15% of the infants, average in 5% of the infants, and none of the infants showed poor response. Regarding the side effects of topical timolol, sleep disturbances and poor feeding were seen in 5% of the infants. Discussion: Timolol is used for hemangiomas that do not involute spontaneously or for infected or ulcerated hemangiomas or those hemangiomas in which there is a risk of scarring, disfigurement, or impairment of vital structures. [ABSTRACT FROM AUTHOR]

We report successful treatment with propranolol in a 4-month-old preterm infant diagnosed as PHACES syndrome based on the presence of a massive facial hemangioma, myoclonic spasms, delayed motor milestones, and posterior fossa anomalies. PHACES is an acronym for posterior fossa brain malformation, cervicofacial segmental hemangioma, arterial anomalies, cardiac defects/coarctation of aorta, eye and endocrine abnormalities, sternal defect, and supraumbilical raphe. The hemangioma was progressively enlarging with ulceration and ocular occlusion. Propranolol was initiated after complete evaluation and resulted in significant regression of the hemangioma without any adverse events or recurrence over a 2-year follow-up period. Mechanism of action of propranolol includes vasoconstriction and inhibition of vascular endothelial growth factor. This case report highlights the importance of investigating all infants with large hemangiomas for syndromes such as PHACES and the need to rule out intracranial vascular anomalies before initiating propranolol. [ABSTRACT FROM AUTHOR]

Infantile hemangiomas (IH) are the most common vascular neoplasm in infants. The typical clinical course of IH follows a pattern of growth (proliferation) followed by spontaneous involution. The majority of IH are isolated to the skin; however, some cutaneous IH can be associated with internal organ involvement or anomalies. IH which are functionally impairing, ulcerated or potentially disfiguring require therapy. Treatment options include systemic or topical beta-blockers, systemic or intralesional corticosteroids, pulsed dye laser therapy, or surgical excision. In this article, we review the updated understanding of IH pathogenesis, clinical presentations and associations, and approaches to management. [ABSTRACT FROM AUTHOR]

Background: Infantile hemangiomas (IHs) are very common vascular tumors. Corticosteroid and propranolol are drugs for the treatment of hemangioma. High dose given for longer duration causes higher side effects. Aim and Objective: The aim and objective of this study was to determine the outcome of a combination of low-dose oral prednisolone with oral propranolol for the treatment of IH. Methods: The study comprised 42 consecutive patients with IH managed with low-dose oral prednisolone and oral propranolol between 2013 and 2016. Patients fulfilling the inclusion criteria were registered through the outpatient department. Diagnosis was confirmed clinically and on Color Doppler. All the patients were given oral prednisolone at a dose of 1 mg/kg/day and propranolol at a dose of 1.5 mg/kg/day. Treatment was given for 4 months and then titrated down for 2 months before the cessation of treatment. Results: Distribution was more on head, face, and neck. The median age at the start of treatment was 4.7 months. Out of the total 42 patients, forty patients responded to therapy (95.2%). Results were found to be excellent in 57.14% of infants and good in 30.95%. Treatment failure was seen in 4.7%. Side effects were not serious and resolved when treatment was discontinued. Rebound growth occurred in two infants (4.7%). No patients suffered drug morbidity. Conclusion: The frequency of acceptable outcome of a combination of low-dose oral prednisolone with oral propranolol for the treatment of IH shows high efficacy, low severe complication rate, and rapid clinical improvement. [ABSTRACT FROM AUTHOR]

Background: Propranolol may be more effective and safer than previously established therapies, and it may be used as a first-line therapy for infantile hemangioma (IH). Propranolol is thought to inhibit the growth of blood vessels by decreasing vascular endothelial growth factor. Aims and Objectives: The aim of this study is to study the efficacy and safety of propranolol in IH and for standardization of dose in tablet form. Materials and Methods: A total of 23 patients with 30 IH s were recruited in the study prospectively, after ruling out any contraindications for oral propranolol and obtaining consent from parents. Patients with <7 kg weight were given oral propranolol 5 mg twice daily and >7 kg weight were given 5 mg thrice daily. Patients were evaluated according to visual analog scale and ultrasonographically on day 0, day 30, day 60, and day 90. Results: Out of a total of 30, 25 (83.33%) were superficial, 3 (10%) were deep, and 2 (6.66%) were mixed hemangioma. All patients with superficial hemangiomas showed a change in the color of the lesion and arrest of growth within the 1st month of therapy and a gradual decrease in size was noticed in 23 (92%, n = 25) patients during the study period except in 2 (8%). Complete clearance was noticed in 68% of patients of superficial hemangioma at the end of the study period. Out of 25 patients, a total of 5 (20%) patients had ulceration at the time of presentation which started to heal within 15 days of therapy. Five (16.66%, n = 30) patients with deep and mixed variety showed arrest of growth but no decrease in size. No side effects were seen except temporary coldness of extremity in 1 (3.33%) patient. Conclusion: Propranolol is safe and effective for treatment of proliferative phase of superficial hemangiomas with very less side effects compared to oral steroids and other recommended therapies, and unavailability of syrup can be overcome by giving tablet in fixed dosage. [ABSTRACT FROM AUTHOR]

Background/Objectives: The efficacy of propranolol as a treatment for infantile hemangiomas (IHs) has been documented. Until now, little has been written about the role of propranolol beyond the proliferation phase of IH. Our aim was to document propranolol efficacy and safety in the treatment of involutive IH. Patients and Methods: Two evaluations were conducted. Investigators evaluated the final clinical results by comparing clinical data at baseline and at the end of the study. Evaluators scored each panel of photographs and were blinded from any clinical information. Both groups used the same scoring system. Patients treated with propranolol in our department between 2009 and 2014 were reviewed. Results: A total of 15 patients with involuting IH treated with propranolol were eligible. Eleven (73%) were females, ranging in age between 16 and 110 months (median 41 months). The types of IH were mixed (n = 13) and superficial (n = 2). The median duration of the propranolol treatment was 20 months (range 6-33 months). The mean size reduction was from 6 cm ± 4.33 before the treatment to 3.98 ± 1.25 at the end of the treatment. The general mean involution according to the investigators' evaluation was 4.1 ± 2.7. The general mean involution according to the evaluators' evaluation was 4.9 ± 1.5. Telangiectasias showed no response. Recurrence was observed in one patient. Transient nightmares were documented in one patient, and nighttime awakenings were documented in another. The therapy was discontinued in neither of these patients. Conclusions: In our experience, propranolol was well tolerated and associated with limited adverse reactions. The use of oral propranolol was effective in the treatment of IH beyond the proliferative phase. [ABSTRACT FROM AUTHOR]

The acronym "PHACE" refers to the syndromic association of posterior fossa anomalies, hemangioma, arterial lesions, cardiac abnormalities/coarctation of the aorta, and eye anomalies. Till now, less than 400 cases of PHACE syndrome have been reported in the medical literature. Its etiopathogenesis is still unknown, and a great deal of genetic and molecular research is required. Moreover, there is always a high probability of misdiagnosis due to the certain factors such as mildly symptomatic patients, hasty diagnosis of relatively common simulating syndromic entities, and low awareness among medical fraternity about the standard diagnostic criteria for PHACE syndrome. Therefore, we report here a case of PHACE syndrome in a 2-year-old female child presenting with Dandy-Walker malformation, microphthalmia, leukocoria, hearing loss, and regressing lesions of large facial infantile hemangioma. [ABSTRACT FROM AUTHOR]

Infantile hemangiomas (IHs) are the most common benign soft tissue tumor of infancy and childhood. Many patients seek early treatment to halt progression of tumor growth and accelerate regression to achieve quick resolution with good cosmetic outcomes. We reviewed literature through PubMed search on the treatment strategies for IH and share our experience in the field of laser treatment of IH. Treatment strategies for IH include both pharmacological, laser, and surgical interventions depending on the stage and severity of the lesion. Various laser beams have been attempted with varying effects and effectiveness. The 595-nm pulsed dye laser therapy has been most widely utilized owing to its great efficacy but minimal adverse effects. It works by targeting oxyhemoglobin chromophore in blood vessels located within the dermis, causing photothermal damage of these target vessels stimulating quick involution without damaging surrounding healthy skin. It is especially useful in treating ulcerated superficial facial hemangiomas that necessitate rapid healing to avoid unsightly scarring. It has a good safety profile but small risk of epidermal burn, blistering, postinflammatory pigment changes, and scarring remains in those with darker skin types treated with higher fluences and short-pulsed duration. Combination treatment with 1064 nm neodymium-doped yttrium aluminum garnet laser, oral propranolol, and even corticosteroids remains an option, especially in treatment of deep, large, and functionally threatening IH. Careful consideration in consultation with the child's parents given the complexities and potential complications surrounding treatment should always be considered. Laser treatment remains an appropriate treatment for rapidly growing IH in exposed locations at early presentation. [ABSTRACT FROM AUTHOR]

Verrucous hemangioma is an uncommon capillary or cavernous hemangioma with reactive epidermal changes of hyperkeratosis, acanthosis, and papillomatosis. Lesions are mostly seen at birth or appear during childhood. These growths are usually located on the lower extremities, and involvement is generally unilateral. Diagnosis of this unusual presentation can only be confirmed following histopathology. Surgical excision resulted in a satisfactory functional and cosmetic outcome. [ABSTRACT FROM AUTHOR]

There are three types of congenital hemangioma - rapidly involuting congenital hemangioma (RICH), partially involuting congenital hemangioma, and noninvoluting congenital hemangioma. We report a case of RICH on the back of a 4-month-old Caucasian male infant, based on ultrasound and magnetic resonance imaging findings in the antenatal period, skin changes at birth, and a normal ultrasound after birth. He was born with an atrophic plaque at the site of the vascular swelling depicted on the scans, suggesting the complete involution of the lesion in the antenatal period. [ABSTRACT FROM AUTHOR]

The use of oral and topical beta blockers has revolutionized the management of infantile hemangiomas. Oral propranolol at 2 mg/kg/d in divided doses not only prevents further proliferation, but actually shrinks IH. Propranolol should be administered for at least 6 months or until the baby reaches one year of age. Side effects to be watched out for include hypoglycaemia, bradycardia and hypotension. Oral propranolol should be prescribed only in those IH where clearly indicated. More cardioselective beta blockers like atenolol are also being explored for treating IH. Topical timolol has been prescribed for smaller and superficial IH or when propranolol is contraindicated. [ABSTRACT FROM AUTHOR]

Introduction: Various medications have been tried to induce regression in hemangioma. We tried to find out the benefits of oral prednisolone versus propranolol in these lesions. Objectives: The objective of this study was to assess the effect of oral prednisolone and propranolol in infantile hemangioma (IH) and also to compare their efficacy. Materials and Methods: This was a prospective study from January 2008 to December 2012. Patients of hemangioma in high risk location with dimension >5 cm and/or area >20 cm2 were included. Patients were randomized into Group A receiving oral prednisolone 5 mg/kg/day in tapering doses, Group B receiving oral propranolol 3 mg/kg/day and Group C receiving both. Patients were evaluated for response and P < 0.05 was considered to be significant. Results: A total of 69 cases were included. Patients in each group were 24, 22 and 23 respectively. Mean age at presentation was 32 weeks (range 6-48 weeks). Therapy was initiated at 30.1 ± 9.2 weeks for 14.9 ± 2.1 weeks. Average tumor size at initiation was 28.2 ± 5.6 cm2 in Group A, 24.9 ± 2.2 cm2 in B and 22.7 ± 2.1 cm2 in C. There was a significant response to treatment in Group A (P = 0.04) and insignificant in B (P = 0.07) and C (P = 0.06). Conclusions: Oral prednisolone is a viable treatment option in the management of high risk IH and there is no added benefit of using propranolol either alone or in combination in the treatment of these cases. A large randomized controlled trial is needed to further validate this observation. [ABSTRACT FROM AUTHOR]

Hemangiomas are hamartomatous proliferations of vascular origin. The prevalence of these lesions is about 7% of all the benign tumors of the body. The clinical appearance of hemangiomas varies depending on the location of the vascular proliferation. Complications though rare, can occur such as ulceration, bleeding either due to trauma or spontaneously as well a pain, making treatment a necessity. Different treatment modalities have been proposed both for cutaneous and oral hemangiomas. These include the use of intralesional injection of sclerosing agents, corticosteroids, and anti‑cancer drugs. Laser therapy, using CO2 and neodymium‑doped yttrium aluminum garnet, has also been utilized. Larger lesions are treated with embolization and surgical excision. A case of hemangioma of the upper lip and labial mucosa in a 9‑year‑old girl, treated with an intralesional sclerosing agent, is being reported. [ABSTRACT FROM AUTHOR]

The article discusses harlequin color change (HCC) in a preterm 33 weeks gestation male neonate diagnosed with meningitis, and mentions topics including differential diagnosis such as port-wine stain and nascent hemangioma of infancy, and HCC's transient nature to help in its differentiation.

The article discusses the medical case of a newborn infant diagnosed with benign hemangiomatosis which is characterized by swelling on the face and mentions the need to investigate the growth of visceral hemangioma.