Infantile hemangioma (IH) is the most common benign hemangioma in infants and young children, with an incidence of up to 10% and a trend of increasing each year. It is significantly more common in females than males, with more than 60% occurring on the face, head and neck. Prematurity and low birth weight (<1500 g) may be predisposing factors, and progesterone use during pregnancy has also been associated with the development of hemangiomas. The distinguishing feature of infantile hemangiomas is endothelial cell proliferation, which can be solitary or multiple and manifests clinically as red patches, papules, hypertrophic patches and masses (nodules) with dilated capillaries. The lesions are divided into proliferative (0-1 year old), regressive (1-5 years old) and complete regressive (5-10 years old) stages according to the course of lesion development. According to the extent of tumor invasion, it is divided into focal, segmental and PHACES syndromes with other malformations. According to the paradigm depth of tumor invasion, it is divided into superficial, deep and compound types. Based on the medical history and clinical examination, the majority of hemangiomas can be clearly diagnosed. When taking the history, two points should be noted: (1) when the initial lesion occurred; and (2) how fast the lesion grew and whether there was rapid growth and regression. Deep subcutaneous hemangiomas sometimes appear as light blue or greenish purple masses, which are easily confused with venous malformations. If necessary, color Doppler ultrasound, MRI or even puncture examinations are needed to clarify the diagnosis and clinical types, i.e. superficial, deep and composite, which are important for choosing treatment. I. Active treatment is still necessary Although IH has the characteristic of self-resolving, it is still impossible to judge whether it can subside on its own and to what extent. The process of natural regression is long, up to several years, and IH tends to occur in the face and neck, causing a large psychological pressure on the child and parents, which affects the early physical and mental development of the child. Therefore, the old "wait and see" treatment strategy must be changed. Therefore, early intervention (<5 months) can control the growth of hemangioma, advance the regression period and shorten the regression process, so as to achieve the ideal aesthetic and functional effects. There are many treatment methods for IH. Radiation therapy, nuclein patching, freezing or injection therapy used in the past have been gradually eliminated due to many sequelae and unreliable efficacy. They are replaced by the latest drug therapy, sclerotherapy and laser therapy. Drug therapy is preferred because it is the most non-invasive and economical treatment method. Surgical resection is not used as the first choice of treatment, but is the last resort considered for the removal and repair of residual lesions (residual masses, scarring, fibrofatty tissue, etc.) of hemangiomas in the regressive phase. Clinically, an appropriate individualized treatment plan needs to be selected based on the site, size, clinical type, age and physical condition of the child with IH. For superficial hemangiomas, 0.5% timolol maleate solution is preferred as a wet dressing or cream, and if it is not effective, propranolol is added. For deep type hemangioma, oral propranolol is preferred, if the effect is not good, add glucocorticoid. For compound type hemangioma, oral propranolol is given, while 0.5% timolol maleate solution is applied as a wet compress or frothy cream. If ulceration or infection occurs, laser irradiation or 0.5% Levanox solution can be used to promote ulcer healing. For severe and life-threatening stubborn hemangioma, anhydrous ethanol can be considered as static push treatment. For capillary dilation left after fading or treatment, 0.25% polysilanol can be injected locally. Although there are many treatment methods for IH, no one method can cure all patients with hemangioma, so clinically, one or more treatment methods must be reasonably selected according to the specific conditions of patients and the advantages and disadvantages of various methods. 1.Pharmacological treatment Commonly used therapeutic drugs include beta-blockers, glucocorticoids, pinyin, alpha interferon, imiquimod, etc. For patients with life-threatening severe disease, chemotherapy drugs such as vincristine and cyclophosphamide can be used. (1) β-blockers: they have replaced glucocorticoids as the first-line treatment for IH because of their advantages of good tolerability, rapid onset of action, significant efficacy, mild side effects and low rebound growth. The simplified treatment protocol we use clinically is: oral beta-blockers, propranolol is routinely used at a dose of 1-2 mg/kg, divided into 2 oral doses. Cardiac ultrasound was done before taking the drug to exclude serious heart disease; detailed medical history was taken to exclude family history of asthma and drug allergy. For children with normal development, no other examination or hospitalization is required. If the drug is effective, continue to take the drug at the initial dose, and repeat every 3 months. If the effect is not good, adjust the dose according to 2mg/kg and follow up every 3 months. If the effect of dose adjustment is still not obvious, a small amount of glucocorticoid can be added. The maximum dose of propranolol is 20mg/d, divided into 2 oral doses. Even if the body weight exceeds 10 kg, the dose should not exceed 20 mg/d. Because of the high sensitivity of Chinese to propranolol, it is still effective when administered at 0.75 to 1 mg/kg. Indications for discontinuation: complete disappearance of hemangioma, or after 12 months of medication. In order to reduce the rebound growth after medication, a gradual discontinuation method of halving the number of times in 2 weeks and halving the dose in the next 2 weeks can be used. After stopping the drug, pay attention to the observation, if the hemangioma is found to increase, it is necessary to take oral propranolol again at the same dose as before stopping the drug for at least 3 months. According to clinical observation, the growth period of a few parotid hemangiomas can be 18 to 24 months, so the drug should not be stopped prematurely. Water-soluble in amiloride (atenolol) is a beta1 receptor blocker with fewer side effects, and can be used as an alternative to propranolol. Timolol is a non-selective beta-blocker, and its strength of action is 8 times that of propranolol. Numerous clinical studies have shown that topical application of 0.5% timolol solution or gel three times a day is very effective for small, superficial hemangiomas, and has become the first-line treatment for superficial hemangiomas, and is recommended to be treated in the early proliferative stage. (2) Glucocorticoids have been relegated to the second line and are less frequently used in the treatment of IH because of their side effects. For larger hemangiomas where oral propranolol alone is ineffective or resistant, propranolol 1.0mg/kg・d and prednisone 0.5mg/kg・d once a day can be given. The combination of drugs can reduce the dose and side effects of single drugs and improve the efficacy. In addition, local injection of glucocorticoids can be considered for focal lesions that are poorly treated with oral or locally applied drugs, and the commonly used drugs are Depo-Provera (compound betamethasone injection) and desoximetasone acetate (tretinoin acetate). (3) Imiquimod Imiquimod is an imidazoquinolamine compound that is commonly used clinically to treat acanthosis, solar keratosis and superficial basal cell carcinoma. It has been used to treat infantile hemangiomas with some efficacy, but it is not recommended for use on important aesthetic areas such as the face and neck because it is irritating and can cause erythema, erosion, blistering, epidermal peeling, and crusting. Because its effect is comparable to 0.5% timolol solution or gel, and the latter has fewer side effects, it is basically replaced by timolol solution or gel at present. (4) Alpha interferon Alpha interferon can be used for the treatment of recalcitrant lesions that have failed to respond to other treatments and are life-threatening, as well as dangerous hemangiomas with thrombocytopenia and coagulation dysfunction (K-M phenomenon). (5) Antitumor drugs including vincristine, cyclophosphamide and pinyamycin are not used as routine. Vincristine and cyclophosphamide are chemotherapeutic drugs with slow onset of action and serious adverse effects such as neurotoxicity, bone marrow suppression, immunosuppression and local irritation. Under special circumstances, they are used for refractory IH and KMP that cannot be controlled by other methods. Pingyangmycin is mainly used for refractory IH with residual lesions in the regression phase or where other methods are ineffective, by infiltrating 8mg/5-8ml of pingyangmycin into the lesion, 1ml/cm², and injecting once at an interval of 3-4 weeks. 2.Laser treatment Parents of children with hemangioma always want to remove the lesions immediately and have high hopes for laser treatment. It is important to understand that the average penetration depth of laser is limited, but it is often used to treat hemangiomas 10 times its thickness, which often backfires and leaves irreversible changes such as scarring, tissue loss, pigment loss or deposition. Laser treatment should not be used as a routine treatment for proliferative hemangiomas, as topical beta-blockers such as timolol solution or gel also have good efficacy and safety for superficial hemangiomas. The pulsed dye laser (PDL) is the standard laser for the treatment of vascular lesions, mainly for early intervention of superficial hemangiomas, management of ulcerated lesions and treatment of legacy capillary dilation during the regression phase. The 595 nm long pulsed dye laser with skin cooling system has superior efficacy to the conventional 585 nm PDL. low-energy PDL irradiation of superficial hemangioma ulcers accelerates wound healing. pdl, long pdl and diode lasers are safe and effective for capillary dilation. Laser treatment is usually performed at the age of 1.5 to 2 years. 3.Surgical treatment Surgery is no longer the treatment of choice for IH. It is generally advocated to be performed before school age and is mainly used to remove lesions that remain after the fading phase or treatment, such as scarring, skin depressions, and fibrofatty residues. Proliferative hemangiomas rarely require surgery, but can be used in special cases such as mass lesions that are a serious threat to function or have a tip. In conclusion, the clinical presentation of IH is complex, with great individual variation, and there is no uniform treatment. The safety and efficacy of beta-blockers such as propranolol have been confirmed and have now replaced glucocorticoids as the first-line treatment for IH. The pediatric drug propranolol hydrochloride by the French multinational Pierre Fabre Dermatologic, which was approved by the US FDA in September 2013, has become the first and only therapeutic agent for proliferative IH. Antineoplastic drugs and sclerosing agents are limited by indications and toxicities and can only be used as second-line therapy. For refractory and complex hemangiomas that are huge or have poor single drug effect, combination of multiple drugs should be considered or combined with other methods such as laser and surgery to achieve better efficacy. For children with residual hemangiomas who have stopped taking propranolol, or who cannot tolerate oral medication, timolol solution or gel is not a useful complementary or alternative treatment.