Cutaneous hemangiomas and vascular malformations are common in infants and young children, and they tend to occur on the head, face, extremities and body surface, which obviously affect the aesthetics and psychological health of the affected children. At the same time, some lesions may cause infection, bleeding, ulceration, etc., and invade mucous membrane, muscle, bone and intracranial parts, causing certain physiological dysfunction. (A) What is hemangioma? Intuitive classification includes nevus, strawberry hemangioma, cavernous hemangioma, and mixed hemangioma. The professional classification includes hemangioma and vascular malformation, and hemangioma includes infantile hemangioma, congenital hemangioma and some special types of hemangioma. 1.Infant hemangioma is the most common, with more female than male infants and higher incidence in premature infants. According to the depth of involvement, they are divided into capillary hemangioma (strawberry-shaped, superficial type), cavernous hemangioma and mixed hemangioma. Superficial hemangiomas are bright red, gradually deepen in color during the proliferative phase, fade to dark purple when fading, and finally show scattered patterned vascular dilatation. 40% of local skin and subcutaneous tissue degenerative changes including scarring, atrophy, depigmentation, vascular dilatation and skin laxity are observed after fading. Deep hemangiomas have elevated surface skin with normal skin tone or translucent blue color. The mixed type has both. The tumor usually appears within a few weeks after birth, and congenital onset is rare; the child proliferates rapidly within 1 year and especially within 6 months, and then gradually enters the receding period, in which the growth of hemangioma gradually stops and begins to recede slowly until the completion of the receding period, which can take up to about 10 years. 2.Congenital hemangioma is usually present after birth, and is divided into rapidly regressing and non-regressing congenital hemangioma. Rapidly receding congenital hemangioma fades faster than infantile hemangioma, and the center often shows depression or scar after receding, and the incidence is not gender specific. Special types of hemangioma (1) kaposi-like hemangioendothelioma: The incidence is equal in both sexes, and most lesions appear before the age of 2 years, and the lesions appear as local infiltrative vascular plaques, or dark inflated hard masses, which do not fade on their own and are often accompanied by severe reduction of platelets. (2) Plexiform hemangioma: More than 50% of these tumors develop within 5 years of age and appear as uneven pink to red papules, patches and aggregated papules that can cover most of the body. Special types of hemangioma are difficult to identify and diagnose clinically and need to be judged based on pathological examination results. 4.Vascular malformations Most of them appear at birth and expand proportionally with the growth of infants. Trauma, infection, hormone level changes, etc. promote the growth of lesions, and there is no gender preference. The midline type microvenous malformation can generally fade away by itself. (B) Does hemangioma need treatment? After the diagnosis and classification of hemangioma are clear, we can roughly judge whether hemangioma needs treatment or not. If the hemangioma is small in size, does not involve special parts, and does not progress or progresses slowly, we can consider follow-up observation. Otherwise, active intervention is needed. Infantile hemangioma is the most common type of hemangioma, and it is in the period of rapid increase in value within 6 months after birth, so it is recommended to treat it as early as possible, usually when the child is 4 weeks old. The location of the hemangioma must be the first factor to be considered. It is recommended to treat hemangiomas located on the face or exposed areas; secondly, some hemangiomas grow in special areas such as eyes, nose, mouth, perineum, and perianal area, or may affect the function, so active treatment is recommended; some hemangiomas have a series of complications such as rupture and infection, or special types of hemangiomas need active treatment. The facial nevus and spider nevus that have no possibility of fading also need active treatment. (C) How to treat hemangioma? 1.Laser treatment: The new laser treatment instrument has selective photothermal effect, and the energy emitted by the laser can selectively act on the hemoglobin in the blood vessels, while minimizing the damage to the normal skin tissue, which can achieve better aesthetic requirements. At the same time, the penetration depth of the laser can reach 4-6mm under the skin, so it can be used to treat most of the common early and superficial hemangiomas in clinical practice. Laser treatment is currently the treatment method with the least side effects, the most direct efficacy and the best therapeutic effect. Although multiple treatments are required, with an interval of about 4 weeks each time, the treatment is relatively simple and convenient, with mild adverse effects, and can achieve better results, so children and parents are more willing to accept it. Therefore, the children and parents are more willing to accept it. The only treatment of choice at present is the recognition of the bright red nevus, spider nevus and granulomatous hemangioma. 2.Medication: Oral hormone therapy has long been the first-line drug for severe hemangioma, and it is more effective for value-added stage hemangioma. A course of treatment usually lasts 1-3 months, or until the tumor stops growing or becomes smaller, and then the dosage is gradually reduced to stop. Common adverse effects include gastrointestinal disorders, Cushing’s syndrome, abnormal blood pressure, increased blood sugar, electrolyte disorders, immunosuppression, etc. Long-term application may lead to complications such as infection. Therefore, it is only used for hemangiomas with thrombocytopenia, coagulation dysfunction, special sites affecting important functions such as vision, swallowing and breathing or causing growth and developmental abnormalities. Propranolol (Takayasu) is a non-selective beta-blocker, mainly used for the treatment of hypertension, cardiac arrhythmia, angina pectoris, etc. Since it was discovered by chance to be effective for hemangioma, it has been used clinically in recent years. Its efficacy is rapid and remarkable, with few adverse effects, and it has now replaced hormones as the first-line drug for infantile hemangioma. Its mechanism of action in the treatment of hemangioma is still unclear, and it is only sensitive to hemangioma in the value-added stage. Generally, the drug is administered 4 weeks after birth, and 4 weeks after full term is recommended for preterm infants, and the course of treatment is 2-17 months, and the dosage should be gradually reduced when discontinued, and the reduction time should be greater than 2 weeks. Common adverse reactions include diarrhea, hypoglycemia, hypotension, bradycardia, bronchospasm, and chills in the hands and feet; and there are no long term studies on safety and adverse reactions. Therefore, propranolol oral can replace hormone as the first-line drug for some severe hemangioma. 3.Other methods: Traditional treatments including freezing, local injection of sclerosing agent or hormone, surgical excision, radiation dressing, intervention, copper needle and other treatments have played a greater role before laser and oral drug treatment, which have been less used because of the large side effects and complicated operation, while often leaving heavy irreversible trauma or scarring. In conclusion, there are many treatment options available for hemangioma, but there is no unified standard and no single method can treat all types of hemangioma, and often multiple treatment methods need to be combined with each other to achieve more satisfactory treatment results. The balance of life, function and beauty is the goal of hemangioma treatment, and the site is always the first factor to be considered. Therefore, before treatment, a comprehensive examination and understanding of the child’s general condition and the specific conditions of the hemangioma lesions, especially the extent of the lesions, is required. The specific treatment and method should be selected according to the patient’s age, the location, type, shape and progress of the tumor, the limitations and adverse effects of specific treatment methods, and the expectations of the child’s parents, in order to achieve the best results in a reasonable and economical manner and to ensure the integrity of the skin function and aesthetics.