Hemangioma manifestations Hemangioma is a benign congenital tumor, mostly appearing 1 week after birth, mostly as an isolated, well-defined red mass on the head and neck, while deep lesions are asymmetrical on both sides of the face with localized cyanotic skin changes. The growth phase is rapid during the first year of life, then stops and begins to shrink between the ages of 1 and 5 and continues until about 10 years of age. Although some of the hemangiomas may resolve on their own, the facial deformities caused before they resolve often cause a heavy and long-lasting emotional burden to the child and family. Also, hemangiomas around the orbit can cause loss of vision or even blindness, those around the ear can cause hearing loss, and those in the pharynx can lead to respiratory difficulties or even life-threatening; moreover, 40% to 50% of the patients with hemangiomas have incomplete regression, with local cosmetic sequelae such as capillary dilation, scar formation, fibrofatty tissue residue and epithelial atrophy. Therefore, in view of the above, it is currently advocated that hemangioma should be treated proactively before it grows rapidly rather than simply observed, so as not to leave behind cosmetic and psychological sequelae, and to minimize the impact on the body. Treatment of hemangioma At present, the main treatment methods for hemangioma are oral medication (glucocorticosteroids or propranolol), laser treatment, cryotherapy and surgery, etc. Except for a few cases (such as giant hemangioma of the eyelid and scalp), surgery is not recommended as the first choice for hemangioma. The depth of cryotherapy is difficult to grasp, the effect is inaccurate, and there is a possibility of adverse effects such as hyperplastic or atrophic scars, pigmentation, and tissue contracture, therefore, it is rarely used in the treatment of facial and neck hemangiomas. Radionuclide patching is effective in treating early superficial skin hemangiomas, but there is a risk of causing complications such as skin atrophy, contracture, pigmentation, pigment loss or alopecia. Radiation therapy has also been used for hemangiomas in the past, but radiation therapy may lead to potential harm to the growth and development of the child, and it is unclear whether tumor development will be triggered later. Therefore, radiation therapy and radionuclide patch therapy have been gradually replaced by other treatment methods. At this stage, it is advocated that the treatment of hemangioma should adopt different treatment methods according to the different stages of its growth, and the principles of its selection are as follows: 1. If small red dot-like lesions are found on the skin soon after birth, treatment means such as pinyamycin injection, laser or surgery should be taken as early as possible to block its rapid growth period and eliminate hidden dangers as early as possible. 2. Hemangiomas that enter the rapid growth phase six months to one year after birth should be treated in a step-by-step manner, i.e. drug therapy (oral propranolol or oral prednisone) → injection therapy (pinyamycin, etc.) → laser therapy (argon laser, pulsed dye laser, Nd:YAG laser, etc.). For hemangioma located under the skin or with larger scope, the effect of single treatment method is often poor, and combined treatment, such as drug + injection treatment, drug + laser treatment, is often needed. 3.The treatment strategy for hemangiomas that begin to fade at the age of 1-5 years is to follow up and observe, and if necessary, to surgically repair residual lesions, scarring, hypertrophic deformities or hyperpigmentation to improve facial appearance. Oral corticosteroid therapy Since Zarem et al. first reported the application of corticosteroids for the treatment of hemangiomas in 1967, hormones have been the first-line drugs for the treatment of severe hemangiomas, with the most common side effects being immunosuppression and growth retardation. However, since the successful treatment of hemangioma with propranolol in 2008, the application of corticosteroids for the treatment of hemangioma is no longer the treatment of choice. The common drug used for oral hormone is prednisone, and the domestic drug regimen is: oral prednisone 3-5mg/kg, once every other morning for 8 weeks; reduce the dose by 1/2 in week 9; 10mg in week 10; 5mg in week 11; stop in week 12 to complete a course of treatment. Propranolol is a non-selective beta-adrenergic receptor blocker, which was mainly used for the treatment of arrhythmia, angina pectoris and hypertension. 2008, Léauté-Labrèze and others from Bordeaux Children’s Hospital in France found by chance that propranolol could effectively control the proliferation of severe hemangioma and promote its regression, and its efficacy in the treatment of hemangioma was also confirmed by other scholars. Propranolol is administered at a dose of 1.0-1.5 mg/kg, 2-3 times daily for 6-8 months, with periodic follow-up and discontinuation depending on the response to treatment, usually until the child is 1 year old. The effect is usually seen in 2 to 7 days, mostly in the form of lighter color, softer texture and reduced size of the hemangioma. It is particularly effective for hemangiomas with ulcers and deeper hemangiomas (e.g., parotid area). The most common side effects are sleep disorder and cyanosis of hands and feet. Other adverse effects include hypotension, hypoglycemia, bradycardia, gastroduodenal reflux, diarrhea, etc. 3.Pingyangmycin intratumoral injection therapy is mainly applied to small-scale hemangioma which is more limited. For patients who have poor effect of oral hormone treatment or who are in the regression period. For the treatment of superficial hemangioma, the concentration of Pingyangmycin is 1mg/mL, and the dose at one time does not exceed 4mg; for the treatment of deep hemangioma, the concentration of Pingyangmycin is 1.5~2.0mg/mL, and the dose at one time does not exceed 8mg; generally for hemangioma with diameter below 37.5px, one injection can cure it; for those with larger tumor or multiple lesions, generally the tumor shrinks significantly after 3~5 injections, and there is a significant reduction in size within 7~30 days after injection. There is a significant effect within 7~30 days after injection. 4.Laser treatment Laser treatment of vascular disease is to treat hemangioma by acting on the oxygenated hemoglobin in the blood vessels to cause vascular damage. There are many types of lasers, mainly argon laser, pulsed dye laser and Nd:YAG laser are used to treat hemangioma. Because of the limited penetrating power of laser, it is mainly suitable for the treatment of early and superficial hemangiomas. For small red skin lesions found after birth, early laser removal can stop them from entering the rapid proliferation phase. When the lesion continues to increase in size during laser treatment, adjuvant medication (oral or pinyamycin injection therapy, etc.) should be considered for treatment. The advantage of laser treatment is that it is easy to operate and can be repeated. The disadvantage is that local scarring and pigmentation are easily left after treatment.