Most hemangiomas shrink (involute) completely and do not require treatment. Nevertheless, all children with significant hemangiomas should undergo a thorough evaluation and continued observation.
Decisions as to whether to treat and when to treat must be made on an individual basis, with consideration given not only to the physical functioning of the child, but also to prevention of permanent disfigurement and the emotional impact of the lesion.
In a small percentage of patients in whom hemangiomas disappear completely, residual fatty tissue or superficial skin telangiectasias (small widened blood vessels on the skin) remain. To improve appearance, these patients may require surgery and/or laser therapy some time during childhood. Even small facial hemangiomas can be treated now with topical agents.
Treatment is dependent upon both the stage of growth (proliferation vs. involution) of the lesion, the presence of complications, and emotional needs and considerations. Observation, laser therapy, drug therapy, and surgical removal are the four most common management options. In some patients, a combination of several of these treatments may be used over a period of time.
Observation. In most cases, observation is the best course to follow, especially when the hemangioma is involuting and your child’s functioning is not impaired.
Laser therapy – Laser therapy is used to treat ulcerated hemangiomas and superficial residual skin telangiectasias.
Drug therapy – Medical therapy is used for complicated hemangiomas in the proliferative phase. Their purpose is to slow the growth and decrease the size of the lesion and to prevent further complications. Medical therapy can be topical, injected, taken orally or given intravenously.
Propranolol – This medication is typically used orally.
Timolol – This is a topical form of a drug similar to propranolol.
Steroids – This medication can be applied topically for small lesions, injected in to the skin or taken orally. Not commonly used at the present time.
Vincristine – This is used for complicated hemangiomas that do not respond to other treatments (used rarely).
Surgery. Surgery may be advised for selected patients, including
(1) children with painful and ulcerated hemangiomas that do not heal;
(2) children whose lesions interfere with breathing, vision, or other vital functions;
(3) those who have hemangiomas that do not completely involute; and
(4) those in whom hemangiomas have resulted in unacceptable scarring or deformity.
Ulcerated hemangiomas may require aggressive wound care, treatment with topical antibiotics, laser therapy, and/or surgical removal.