Overview Hemangiomas are often invisible at birth, and most lesions are found within the first month of life, starting as small red spots that grow rapidly and stop growing around the age of 1 to 2 years and gradually degenerate and heal themselves. It is three times more common in females than in males. The name is due to its strawberry-like shape. In addition to occurring on the skin, it can also involve subcutaneous tissue and muscle tissue, and generally does not invade bone tissue. Kasabach-Merrit syndrome is a relatively common syndrome associated with capillary hemangioma and was first reported in 1940. It presents as a large capillary hemangioma with thrombocytopenic purpura in infants and children. The purpura is not simply due to thrombocytopenia, but is also the result of a wasting coagulopathy. This syndrome accounts for only 1% of the infant and child population with hemangiomas, but has a 50% mortality rate. The clinical presentation is usually a small, prominent nodular mass of bright red or dark red color, clearly demarcated from normal skin. The surface is warty or lobulated, shaped like a leafy strawberry. The tumor is soft and compressible. They occur on the face, scalp, neck, back of the shoulder, and vulva, but also on any part of the body. Multiple cases can be mixed with cavernous hemangioma, which is called mixed hemangioma. Diagnosis (1)Most of them appear from 1 month to 2 months after birth, the initial appearance is as big as a pinhead to a soybean, gradually increasing in size and entering the proliferative phase, and slowly entering the degenerative phase around the age of 1 year, with most children degenerating around the age of 5 years; (2)Dark red or bright red elevation, soft in texture, receding when pressed, no conscious symptoms; (3)Mostly found on the face, but also on the neck, chest, back and other parts. Differentiation (1) Bright red nevus: bright red patches that fade when pressed, do not protrude from the skin, and are usually visible at birth and do not fade naturally. Pathological examination shows capillary dilation and no abnormal proliferation of vascular endothelial cells; (2) Spongiform hemangioma: elevated bright red or purple-red tumor, which can shrink when pressed and revert to its original shape after decompression, mostly appearing at birth and not fading. After 3 to 6 months of rapid growth, 70% to 80% of hemangiomas can gradually degenerate and heal on their own within 5 to 7 years. Therefore, instead of active treatment in early childhood, close follow-up is performed to observe the changes. However, there are still some hemangiomas that not only do not regress on their own, but also continue to develop, and in serious cases, disfigure the appearance, cause dysfunction in the area where the tumor is located, or bleed more than once when the hemangioma is injured, or even develop secondary infections that do not heal over time. Therefore, for hemangiomas located in the eye, nasal cavity, external ear canal, oral cavity, vulva and perianal area, if the tumor grows rapidly, it will seriously affect the appearance, function and development of the child and cause great psychological stress to the parents of the child. In this regard, we should actively search for safe and effective methods for early treatment. Only when the lesions are correctly differentiated from the proliferative, stable or regressive stages, can we choose the correct treatment. For hemangioma in early proliferative stage, except for cases without obvious proliferation, the concept of active treatment should be established, and the use of treatment to block a certain part of the angiogenesis process at this time is beneficial to prevent various complications caused by the proliferation of lesions and later recovery of appearance. Proliferative hemangiomas usually occur within one year of age and tend to grow faster especially within six months. On the basis of correct diagnosis and staging, the following methods can be chosen according to the specific situation. A. Steroid (hormone) treatment In 1967, Zarem and Edgerton first reported that steroid treatment for hemangioma had achieved certain efficacy, and since 1983, this treatment method has been carried out in China, and a large number of cases have been treated, with an efficiency of about 80%, among which mixed hemangioma has the best effect. Therefore, the basic principle of oral corticosteroid therapy and local hormone injection therapy for hemangioma may be to control the angiogenic process of abnormal proliferation of capillary endothelial cells in hemangioma and the formation of infantile neovascularization to achieve the therapeutic effect on proliferating hemangioma. The time to effect of vascular treatment varies from person to person, and the growth may be discontinued in 10 days in short cases. The early effect of treatment is the cessation of tumor growth, not the immediate regression. The treatment leads to the early stabilization and regression of hemangioma, which is characterized by the softening of the tumor, the beginning of whitening of the surface, the appearance of skin wrinkles, the cessation of growth, and the complete regression, which is a long process of several years. It is worth emphasizing that not all hyperplastic hemangiomas are sensitive to hormone therapy, and hemangiomas that do not show effective performance in the first course of treatment suggest that they are not sensitive to hormone therapy and should not be treated with high doses of hormone therapy. It is not reasonable to administer hormone therapy to hemangiomas that have already entered the regressive phase because the process of vessel formation has been discontinued. In conclusion, oral hormone therapy is currently the preferred method to effectively accelerate the natural regression of refractory, multiple, and critically ill infantile hemangiomas. In a large sample of patients, there are few significant or serious complications in those who are treated with conventional medications. Local injection therapy is also an option for very limited, small lesions, and it is worth noting that the potential for complications is more pronounced than with oral medication. However, steroid treatment should be strictly controlled for the indications. The efficacy of steroid treatment is obvious for hemangioma during the rapid growth period of infants within 1 year of age. In the late 1980s, steroid corticosteroids were used at home and abroad to treat infantile hemangiomas, and the efficacy was especially prominent in neonates with huge mixed hemangiomas. sloan (1989) used local injection of hormone, that is, a mixture of betamethasone acetate was injected 0,1 ml to 5 ml according to the size of the lesion. laser treatment side effects: increased or decreased appetite, temporary facial edema, excitement, hairiness, polydipsia and other symptoms. Polyuria and other symptoms. Gun reported a decrease in T-lymphocyte function and abnormal immune function after taking only two doses of hydrocortisone. B. Pingyangmycin treatment (1) Principle and method Pingyangmycin, as a new type of anti-tumor antibiotic, has mild side effects and basically no damage to hematopoietic and immune functions. Injecting Pingyangmycin into hemangioma can rapidly inhibit the proliferation of endothelial cells in blood vessels and blood sinuses, thus inhibiting their development and eventually promoting their regression. (2) Efficacy assessment The efficacy is evaluated after three months or more follow-up after intravascular injection of Pingyangmycin. ⅠCure The tumor body basically disappears, leaving mild pigmentation on the surface and no scar; ⅡSignificant effect The tumor body volume is obviously smaller, the color basically disappears, and the unique softness of hemangioma disappears when touched. ⅢEffective The tumor volume does not increase or becomes slightly smaller, the color becomes darker, and the surface appears depression; ⅣInvalid The tumor does not decrease in size or increases in size compared with before. According to the above evaluation criteria, the application of intratumoral injection of Pingyangmycin has been applied to more than 1000 cases, and the effective rate reached more than 90%, with an average efficacy of 2 to 3 times, and no serious adverse reactions were seen. Therefore, small-dose intratumoral injection of Pingyangmycin is one of the effective methods to treat hemangioma. C. Radiation therapy Radiation therapy has a relatively long history. Because radiation therapy has a significant inhibitory effect on many proliferating hemangiomas and can shorten the time to enter the regression period, it can help many cases to regress faster. Historically, various methods such as X-ray, isotope dressing, radium irradiation and isotope colloid injection have been used, and the heyday of its treatment for hemangioma was formed in the United States from 1930 to 1950. The vascular endothelial cells of proliferating hemangioma are in a childish proliferative state and have a high sensitivity to radiation therapy. After treatment, the angiogenic process stops, the capillary hemangioma occludes and degenerates, and appears to be similar to fading performance, and the effect is more reliable and objective. However, complications such as local skin pigmentation changes, especially hypopigmentation, scar formation and capillary dilation may occur due to radiotherapy, leading to the impact on the final effect of the skin after regression; in addition, radiation therapy at excessive doses may even cause complications such as inhibition of bone growth centers, deep tissue damage and chronic radiation dermatitis. Although Li and Cassady (1974) had followed a larger sample of the treatment group for up to 20 years and concluded that there was no increase in tumor incidence in the distant future, many complete case reports found that after 20 to 30 years, some patients who received even very low doses of radiation therapy developed sarcomas in the treated area; after low-dose radiation therapy to the neck, thyroid and salivary gland tumors and The risk of distant involvement of parathyroid failure increases after low-dose radiation therapy to the neck; radiation therapy to the chest leads to limited breast development in the later stages, etc. These phenomena overshadow the development of radiation therapy, especially after the emergence of hormone therapy, the use of radiation therapy is greatly reduced. D. Interferon therapy Interferon alpha-2a can block the migration and proliferation of endothelial cells, and can impede other steps of angiogenesis by blocking the stimulating effect of fibroblast growth factor on vascular endothelial cells. The method of administration is: subcutaneous injection of interferon 3 million U/square body surface area at intervals of typically 7 to 10 months. No adverse effects have been observed in the application. Temporary side effects include fever and neutropenia. This drug is used only in large areas that are not effective to hormonal and laser treatments. Interferon therapy, which has emerged in recent years, is a new attempt for complex and severe hemangiomas. The possible mechanism of action of interferon lies in the inhibition of endothelial cell proliferation and other steps of angiogenesis. white (1989) first successfully treated a patient with pulmonary capillary hemangiomatosis with interferon alpha-2a. The main indications for interferon treatment of hemangioma are currently considered to be: as a life-threatening hemangioma in infants and children with severe disease that occupies and invades major organs or channels, grows on the extremities at risk of amputation, and is not treated with the corticosteroid system; in Kasabach- Merritt syndrome, it can be used as a first-line agent. Transdermal injection and administration by body surface area are generally chosen. Due to the small number of cases, further in-depth studies on this treatment are needed. E. Surgical treatment In principle, for small lesions that are confined and can be directly excised and sutured, surgical excision is entirely possible at the early stage of hyperplasia, and can be considered even for infants and children shortly after birth. The sutures should be as fine as possible, so that not only is radical cure likely to be achieved, but also the impact on appearance at a later stage is minimal. If the appearance of receding hemangioma is not satisfactory, such as residual fibrofatty hemangioma or skin discoloration with loosening, etc., it is also possible to improve the appearance by surgery before or later in school. F. Laser treatment In recent years, laser has been used to treat various skin vascular diseases, especially Ultrapulse adjustable pulse width 532 nm wavelength laser has achieved certain efficacy in the treatment of strawberry angioma. Its principle is mainly dependent on selective photothermal action. Selective photothermolysis means that the capillary hemoglobin has a peak absorption near 580 nm wavelength, while the surrounding tissue absorbs less heat, and the principle of heat dissipation between pulses to achieve a highly selective thermal coagulation of hemoglobin, which eventually leads to vascular occlusion. Prognosis Children with strawberry hemangioma have no conscious symptoms or functional impairment, and treatment is aimed mainly at addressing cosmetic appearance. Bowers pratt reports that approximately 70% of children with hemangiomas regress completely by the age of 5 to 7 years, with some regression delayed until the age of 10 to 12 years, as indicated by a change in color from red to grayish-yellow, softening, and loosening of the surface skin with folds. Completely degenerated hemangiomas may be unmarked, with nearly normal or slightly pale skin; some degenerated hemangiomas have excess skin and soft, thin fatty tissue, scarring, and dilated capillaries. A small number of hemangiomas involving skin and muscle vessels may cause secondary infection or ulceration, or even hemorrhage. Therefore, infants and children with hemangiomas should be actively monitored for changes in order to determine treatment. Follow-up is an ideal option for fading lesions that are not amenable to surgery or have a poor postoperative appearance, and for proliferating hemangiomas that are slow growing or even nearly quiescent.