Lesion development in infantile hemangiomas

Infantile hemangioma (IH), the most common benign tumor in infants and children, is caused by excessive proliferation of normal vascular tissue. It usually occurs on the head, face and neck, followed by the extremities and trunk. The incidence is 1.1%~2.6% in newborns. It is more frequent in female than male infants, with a ratio of 2-5:1, and is therefore also thought to be associated with increased estrogen levels. The clinical manifestations depend on the location and size of the lesion and the period in which the lesion occurs, including tenderness, ulceration, and bleeding. The lesions are divided into proliferative, regressive, and complete regression stages according to the course of lesion development. Proliferative hemangiomas often appear as pale spots at first, followed by capillary dilation surrounded by a halo-like whitish area. Infants and children exhibit two typical periods of rapid growth within the first year of life, with the first period of rapid growth occurring 4 to 6 weeks after birth and the second at 4 to 5 months of age. Hemangiomas grow rapidly during these 2 periods and exhibit corresponding clinical symptoms such as tenderness, ulceration, and bleeding. The clinical manifestations of hemangiomas depend on the location and size of the lesion and the period in which the lesion occurs. More superficial proliferative hemangiomas often appear as bright red spots or nodular lesions, while more advanced lesions have a cyanotic surface or no color change. The regressive phase usually occurs at the end of the first year of life (12-14 months), when the growth of the tumor slows down. The transition from the proliferative phase to the regressive phase is a gradual process, with entry into the regressive phase being precipitated by a marked slowing of the growth rate and softening of the texture of the tumor. When a cutaneous or subcutaneous hemangioma enters the regressive phase, the color of the tumor changes from bright red to dark gray, and the tumor gradually fades and shrinks. It is generally believed that the natural regression rate is 50%-60% within 5 years of age, 75% within 7 years of age, and up to 90% or more within 9 years of age. Most cases undergo a regression period of 2 to 5 years. There are many ways to treat hemangioma, including drugs, freezing, laser, sclerotherapy, etc. However, it is important to emphasize that the goal of IH treatment is not only to eliminate the lesion, but also to maintain healthy normal tissue and appearance. Including laser and freezing should have strict indications and are not applicable to every patient. Proliferating hemangiomas in non-critical areas that are small in size or in a stable growth phase and have not caused important effects on aesthetics and function can be observed on a regular follow-up basis; hemangiomas in a receding phase can be observed on a regular follow-up basis. During the observation period, the growth of hemangioma should be monitored by objective methods such as digital photos or precise measurements. In general, individualized treatment plans should be promoted.