Thanks to the advancement of medical knowledge and technology, there are several treatment options available today for children with vascular birthmarks. In some cases, though, careful observation may still be the best course of action, particularly for smaller hemangiomas of infancy that are not in a cosmetically sensitive location.
The following treatments are available at our Center:
Cortisone Injections/Systemic Steroids
Cortisone (steroid) can be injected directly into hemangiomas of infancy or given orally by mouth. If given orally for prolonged periods, cortisone has side effects including increased risk of systemic infection, high blood pressure, diabetes, increased appetite, stomach irritation, and growth suppression. The risk-benefit ratio of using this medicine must be monitored closely by a treating physician.
This therapy is limited to the most severe and potentially life-threatening hemangiomas. It involves administering systemic medication via daily shots, usually into the leg, for several months. It is usually given to the baby by the parents under physician direction and supervision. This therapy has serious potential side effects, including neurologic effects, blood abnormalities and others.
Since the initial article in The New England Journal of Medicine by Léauté-Labrèze et al, hundreds of publications in medical literature have documented the efficacy and overall safety of propranolol in the treatment of hemangiomas of infancy. Former therapies such as systemic corticosteroids and chemotherapies are now prescribed much less often, given their side effects.
Patients must be monitored closely for changes in blood pressure and any other adverse effects, including unresponsiveness secondary to low blood sugar. For these reasons, this medicine should be prescribed under the care of a pediatric dermatologist who has had much experience in using the drug.
Pulsed Dye Laser Therapy
Pulsed dye lasers now in use at Rady Children’s can safely remove or diminish lesions with little or no scarring and minimal anesthesia, even in infants as young as a few days old. The modality of therapy treats the superficial blood vessels best. Early treatment of these lesions means young children can have birthmarks removed before psychological effects or possible physical complications can occur. In a process called “photothermolysis,” treatment with this laser specifically targets abnormal blood vessels, allowing physicians to permanently eliminate blood vessels just below the surface of the skin, without damage to the surrounding tissue.
Treatments are routinely done in an outpatient surgical office setting, lasting an average of five to 20 minutes, depending on the size of the lesion. Longer treatments may be necessary for very large areas and may require general anesthesia. Many children with vascular lesions experience a 50 percent clearing of the lesion with a single treatment. Other lesions may require six to 12 treatments, or even more, depending on the severity of the lesions. Each treatment is spaced two to four weeks apart.
Patients have compared the sensation of the lasers to the snap of a rubber band against the skin. However, topical numbing cream may be used to decrease the discomfort. Also, newer lasers used at Rady Children’s have a “cooling hand-piece” that decreases pain and also allows stronger pulses to treat birthmarks that have not been responsive to prior laser therapy.
Following treatment, ice packs may be used to soothe the treated area. Topical antibiotic ointment and a bandage or patch may prevent abrasion of the treated area; however, these are usually unnecessary.
|Before Pulsed Dye Laser Therapy||Mid-Therapy||After|
At Rady Children’s, sclerotherapy is a procedure performed by pediatric interventional radiologist, Sean Pakbaz, M.D., who specializes in the treatment of vascular malformations. Sclerotherapy is generally used for slow-flow malformations, such as venous or lymphatic malformations. It is a procedure that can be performed by injecting a sclerosing agent, such as alcohol or chemical detergents, through the skin directly into the target blood vessels. The irritating sclerosant then causes severe irritation within the blood vessel, causing a clot to form, and effectively closing off the treated vessel. Ligation of the vessels leading to the vascular malformations has led to dramatic results in many patients, including resolution of their vascular malformations.
Sometimes, the decision is made by our team to treat a vascular malformation with sclerotherapy prior to surgical excision. This is often beneficial, as it may shrink the lesion and therefore minimize the risks of surgery. This combination of treatments has led to outstanding results in many of our patients.
Ralph Holmes, M.D., a pediatric plastic surgeon, and Anthony Magit, M.D., a pediatric otolaryngologist, are outstanding surgeons with many years of experience in excising vascular birthmarks. The most common vascular birthmarks requiring excision are hemangiomas of infancy. Although these vascular tumors regress over time, indications to excise these lesions may include risk of functional compromise of vital organs, location in a cosmetically-sensitive area that will eventually require excision, remaining fibro-fatty tissue after regression of the hemangioma, and any lesions that may cause a psychological impact on the child.
Our team evaluates vascular tumors or malformations clinically and radiologically before recommending birthmarks for surgical excision. Lesions that are confined to the subcutaneous tissues (not involving the underlying muscle and fascia) can often be easily excised under general anesthesia with minimal risk to the patient and excellent cosmetic results.