You are seeing an 8-month-old boy for the first time. His parents are concerned about a birth mark on his chest that has enlarged slowly over the past 5 to 6 months.
Of the following, the MOST appropriate management of this lesion is
A. Interferon-alfa
B. Intralesional corticosteroid
C. Observation
D. Pulsed dye laser
E. Systemic corticosteroid
ANSWER: FRIDAY 23/11/2018 AT 10 AM
C.
ReplyDeleteHemangiomas represent benign vascular tumors that are present in 1% of newborns and approximately 10% of 1-year-olds. They may be separated clinically into three types:
ReplyDelete Superficial: Bright red plaques or dome-shaped papules or nodules
Deep: Compressible nodules or tumors that have a bluish hue and often surface telangiectasias
Mixed: Lesions that have both superficial and deep features
Most hemangiomas follow a benign course and do not threaten vital structures. Typically, they grow rapidly during the first 6 to 9 months after birth, stabilize, and subsequently begin to involute. The clinical hallmark of involution is the appearance of a gray or white discoloration on the lesion’s surface. Complete involution is seen in 30% of children by 3 years of age, 50% by 5 years, 70% by 7 years, and 90% by 9 years. The infant described in this case has a superficial hemangioma that is exhibiting signs of involution. Therefore, no intervention is necessary, and the family should be counseled about the lesion and its natural history.
A variety of treatment options are available for problematic hemangiomas. Intralesional corticosteroids may be used for localized lesions, such as those involving the nasal tip or ulcerated lesions in the diaper area. Proliferating lesions that threaten a vital structure (eg, the eye, are large, or are associated with systemic symptoms (eg, thrombocytopenia or disseminated intravascular coagulation as part of Kasabach-Merritt syndrome typically are treated with oral corticosteroids.
Interferon-alfa is an inhibitor of angiogenesis that often is beneficial in the management of
hemangiomas that fail to respond to systemic corticosteroid therapy. Hemangiomas that do not involute completely or ulcerated lesions that do not respond to local care may benefit from pulsed dye laser treatment.
SO CORRECT OPTION IS ‘C’.
References:
Bruckner AL, Frieden IJ. Hemangiomas of infancy. J Am Acad Dermatol. 2003;48:477-493.
Abstract available at:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12664009
Krowchuk DP, Mancini AJ, eds. Infantile hemangioma. In: Pediatric Dermatology. A Quick Reference Guide. Elk Grove Village, Ill: American Academy of Pediatrics; 2007:285-293
Paller AS, Mancini AJ. Vascular disorders of infancy and childhood. In: Hurwitz Clinical Pediatric Dermatology. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2006:307-344
Weston WL, Lane AT, Morelli JG. Vascular lesions. In: Color Textbook of Pediatric Dermatology. 3rd ed. St. Louis, Mo: Mosby; 2002:89:187-201