Infantile hemangiomas: new frontiers.

Guest Editorial I t is a very exciting time for clini-cians who are confronted with infantile hemangiomas. So much new information is now available regarding pathogenesis, epidemiology, differential diagnosis, and therapy. These aspects are reviewed in greater detail in the accompanying articles by a group of experienced scientists and clinicians, who help provide a richer and more sophisticated understanding of these common vascular lesions. Hemangiomas are common vascular tumors of infancy. These tumors have a largely predictable course of proliferation , plateau, and eventual involution. As a result, pediatric clinicians confronted with hemangiomas have traditionally emphasized active nonintervention for uncomplicated lesions. Recent observations have suggested that earlier evaluation and consideration of earlier intervention for infantile hem-angiomas may lead to better outcomes for affected infants. The most rapid period of hemangioma growth may occur earlier than originally thought. Reviews of serial photography at 1-to 2-week intervals over a 6-month period indicate that the growth velocity of hemangiomas is greatest between 5.5 and 7.5 weeks. Anatomic sites with hemangiomas that could become problematic therefore ideally should be evaluated before 8 weeks of age so that effective interventions can be initiated. 1 Whereas older studies have reported that hemangiomas leave re-sidua in about 10% to 15% of cases, a more recent report looked for any signs of hemangioma residua and found that 69% of involuted hemangiomas demonstrate remaining telangiectasia, atrophic scar, skin surplus, erythema, pigmentary disturbance, or some other textural abnormalities. 2 Although some families may be satisfied with some of these changes, others may not find these acceptable; earlier intervention may provide an improved outcome for these children. Complications may arise as a result of hemangiomas being located at inconvenient anatomic locations, developing ulceration, or having associated em-bryologic malformations (as seen with segmental hemangiomas of the head and neck or in the lumbosacral and genital areas). Systemic corticosteroids had long been the mainstay of treatment for complicated hemangiomas. However, treating individual patients with steroids required a careful weighing of predicted benefits against potential risks of prolonged therapy. 3 The serendipitous discovery of beta-blockers as an effective treatment of infantile hemangiomas has led to these agents largely supplanting corticosteroids as first-line therapy. Whether beta-blockers should be initiated in the hospital setting or the outpatient setting remains to be determined, but a large multicenter, international clinical trial as well as smaller clinical trials are underway to determine how these agents should best be administered. …