I. What is the natural course of hemangioma? What are the consequences? The natural course of hemangioma can be divided into: the proliferative phase, the stable phase and the receding phase. The proliferative phase is usually 6-8 months, but in some cases it can last for more than a year. Some of them grow very slowly, while others involve a large area of normal tissue within a few weeks and expand deeper and more destructively. Satellite foci often appear first around the surface lesions and later gradually fuse with the center, or they may grow in a polycentric fashion. Some manifest as multiple lesions throughout the body. The tumor usually enters a stable stage around one year of age, when the tumor growth stops. The regression phase is indicated when grayish white dots appear in the lesions and gradually enlarge or fuse, and the subcutaneous masses begin to soften. The regression of limb hemangiomas is faster than that of the face. An important feature of the natural course of these hemangiomas is their self-resolution, the mechanism of which is not yet known (the pathological basis is infantile capillary degeneration replaced by fibrous and adipose tissue), and 75-80% of children are expected to achieve complete self-resolution by age 7. Under what circumstances is it appropriate to observe infantile hemangioma without treatment? For hemangioma in the early stage of proliferation, unless there is no obvious proliferation or proliferation is very slow, the concept of active treatment should be established in general. At this time, the use of treatment to block a certain part of the angiogenesis process is conducive to preventing various complications caused by the proliferation of lesions and the recovery of appearance at a later stage. Especially for the parts of the face that are obviously involved in the appearance, we should not wait for the natural fading of the lesions, because the lesions can bring physical and mental trauma to the children and parents for several years or even more than ten years. Where do infantile hemangiomas usually occur? Are there any complications? The concept of infantile hemangioma is limited to tumors of vascular origin characterized by the proliferation of vascular endothelial cells. Vascular disease consisting of endothelial and lining vessels that do not have the tendency to proliferate becomes a vascular malformation. Infantile hemangiomas can occur anywhere in the body, mostly in the skin and subcutaneous tissues (mostly head and face), followed by the oral mucosa and muscles, then the liver, bones, spleen and nervous system, and occasionally in the digestive tract, kidneys and other tissues. Complications of hemangioma include: 1. Local complications: bleeding; infection; ulceration; necrosis. 2. Systemic complications: Kasabach-Merritt syndrome; compression of vital organ tissues (cervicofacial hemangioma); congestive heart failure and gastrointestinal bleeding. The most serious complications of hemangioma are: Kasabach-Merritt syndrome, which is characterized by large capillary hemangioma with thrombocytopenic purpura in infants and young children, and the purpura is not simply due to thrombocytopenia, but is the result of consumptive coagulopathy. What is the treatment for infantile hemangioma? What is the latest drug treatment? For hemangioma in the early stage of proliferation, except for cases with no significant growth, we should generally establish the concept of active treatment, at this time, the use of treatment to block a certain part of the angiogenesis process is beneficial to prevent complications caused by hemangioma proliferation and later recovery of appearance. Laser treatment: Pulsed dye laser is preferred and is generally less likely to cause secondary scar formation and pigment changes, but due to the weak penetrating ability of laser, usually less than 1.5mm, it should only be applied to superficial, small and slow growing or stopped growing strawberry hemangioma, and on the premise that no scar formation and permanent pigment changes will occur. This requirement can only be fulfilled if the case is appropriate and by experienced personnel. In addition, treatment with non-selective photothermal action of Nd, YAG, CO2 laser, etc. has tended to be eliminated. 2, sclerotherapy: treatment operation is simple and widely used. The role of different sclerosing agents vary, either through blood clotting and thrombosis of the blood sinus, or lead to intimal damage and local tissue fibrosis and play a role. Commonly used sclerosing agents include anhydrous alcohol, sodium cod liver oil acid, urea, pinyamycin (and the newest polyglaucine), etc. Hypertonic sodium chloride, and herbal preparations have similar results. Sclerotherapy requires patient observation and long-term adherence, for a significant proportion of cases can avoid the trauma associated with surgery. 3. Hormone therapy: oral corticosteroids and local hormone injections for hemangioma control the proliferation of hemangioma capillaries and endothelial cells through the inhibitory effect on angiogenesis. The classical prednisone oral regimen: 4mg per kg of body weight, taken every other morning for 8 weeks, and then reduced by half every week with an interval of 2-3 weeks, usually taking no more than two courses of medication. It is commonly used in large area of head and face proliferative hemangioma, systemic multiple proliferative hemangioma and with various complications, or with proliferative phase affecting normal physiological function. If the dose of hormone treatment is large, the course of treatment is long and complications are present, the indications should be strictly controlled. Hemangioma without effective performance in the first course suggests insensitivity to hormone therapy and should not be treated with high doses of hormone therapy. Parents should be informed of possible adverse reactions before treatment and should be closely followed up. 4. Radiation therapy (including isotope therapy): Radiation therapy inhibits the proliferation of hemangioma, shortens the time to enter the regression period, and helps the hemangioma to subside. There are X-ray, radionuclide dressing, radium irradiation and other methods. The treatment effect is reliable and objective. However, it can cause local skin hypopigmentation, scar formation and capillary dilation, which affect the final result of the skin after hemangioma regression. And there is a possibility of malignant tumor in the long term. 5. Cryotherapy: Cryotherapy has therapeutic significance for fast-growing hemangioma with small area located on the skin surface, which can shorten the time to enter the receding period through direct healing of hemangioma or stop its growth. 6. Surgical treatment: In principle, for small lesions that are limited and can be directly excised and sutured, surgical excision can be performed at the early stage of growth, but it should be expected that the incision should be inconspicuous after surgery, and it can be considered even for infants and children shortly after birth. For receding hemangioma with unsatisfactory appearance, such as residual fibrofatty hemangioma or skin discoloration with laxity, etc., the appearance can be improved by surgery. 7. Other methods: microwave therapy, interventional therapy under fluoroscopy, and high-energy ultrasonic therapy have been used in clinical practice, but their clinical application is limited due to the defects of the treatment methods themselves. The latest drug treatment for hemangioma: In recent years, propranolol has been used orally for the treatment of hemangioma with satisfactory results, especially for multiple, head and face or special parts of hemangioma, when local treatment is difficult. After excluding cardiopulmonary diseases and contraindications, 1,2~1,5mg/kg is given orally once daily with regular review of ECG and blood glucose. The minimum heart rate should not be less than 80 beats/min. Take it for 6~9 months and gradually reduce the dosage and stop it. At present, some hospitals in China use it as the first treatment method. V. What are the indications for hormone therapy? Are there any toxic side effects? Oral corticosteroids and local hormone injections for hemangioma control the proliferation of capillaries and endothelial cells through the inhibition of angiogenesis. They are commonly used in large area of proliferating hemangioma on the head and face, multiple proliferating hemangiomas throughout the body and with various complications, or those with proliferating phase affecting normal physiological functions. If the dose of common hormone treatment is large, the course of treatment is long, and there are complications, the indications should be strictly controlled. Hemangioma without effective performance in the first course suggests insensitivity to hormone therapy and should not be treated with high doses of hormone therapy. Common toxicities: temporary slowing of body growth, Cushing’s syndrome-like face, behavioral changes (e.g., irritability, crying), gastrointestinal ulcers, weight gain, infections, hypertension or hypertrophic cardiomyopathy. Those who use the drug as prescribed rarely have obvious or serious complications, and even if complications such as obesity occur, they can gradually recover after stopping the drug. VI. What are the most common complications of hemangioma? The complications of hemangioma are: 1. Local complications: bleeding; infection; ulceration; necrosis. 2. Systemic complications: Kasabach-Merritt syndrome; compression of important organ tissues (cervicofacial hemangioma); congestive heart failure and gastrointestinal bleeding. The most serious complications of hemangioma are: Kasabach-Merritt syndrome: it is manifested as large capillary hemangioma with thrombocytopenic purpura in infants and children. The purpura is not simply due to thrombocytopenia, but is the result of consumptive coagulopathy.