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December 15, 2008

Infantile Hemangiomas With Unusually Prolonged Growth Phase: A Case Series

Author Affiliations

Author Affiliations: Department of Dermatology, Harvard Medical School, Boston, Massachusetts (Dr Brandling-Bennett); Departments of Dermatology and Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston (Dr Metry); Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (Dr Baselga); Department of Dermatology (Dr Lucky) and Division of Hematology/Oncology (Dr Adams), Children's Hospital Medical Center of Cincinnati, Cincinnati, Ohio; Department of Dermatology, Hospital de Pediatria, J. P. Garrahan, Buenos Aires, Argentina (Dr Cordisco); and Departments of Dermatology and Pediatrics, University of California, San Francisco (Dr Frieden).

Arch Dermatol. 2008;144(12):1632-1637. doi:10.1001/archderm.144.12.1632

Background  Most infantile hemangiomas (IHs) complete their proliferative growth phase before 9 months of age, but those with unusually prolonged growth create unique clinical challenges. We performed a retrospective case series of IHs with prolonged growth to further characterize these lesions and their treatment.

Observations  We identified 23 patients as having IHs with prolonged growth after 9 months of age, with growth to a mean age of 17 months. All of the IHs had a deep dermal to subcutaneous component, all had either segmental or indeterminate morphologic characteristics, and 39% involved the parotid gland. A total of 20 of 23 received prolonged treatment with systemic corticosteroids (mean duration of treatment, 11 months), and 9 of 20 received additional systemic therapies (vincristine sulfate and/or interferon alfa-2a or alfa-2b).

Conclusions  Prolonged growth was observed primarily in IHs with a deep component and segmental morphologic characteristics. Recognition of this subset of hemangiomas is important for clinicians, and further study of IHs may provide clues to their pathogenesis.