Treatment: how to treat hemangioma in children and adults?

In most cases of childhood haemangiomas, a wait-and-see approach is used. They are known to spontaneously regress, i.e. disappear.

However, hemangiomas that grow rapidly, are larger and are in an unfavourable location require targeted treatment.

Beta blockers, such as propranolol, are the most commonly used first-line treatment.

Side effects of propranolol include:

• Slowing of the heart rate
• lowering blood pressure
• bronchospasm
• hypoglycaemia

A cardiological examination is required before any beta blocker treatment is started. Treatment lasts approximately 9-15 months.

The second type of treatment is systemic corticosteroids, but their mechanism of action in the treatment of haemangiomas is not entirely clear. Dosage is controlled according to weight and usually lasts 6-8 weeks.

Side effects of corticotherapy include:

• Irritability
• sleep disturbances
• increase in blood pressure
• bone decalcification
• heart damage
• growth retardation in children

The effect of corticosteroids is manifested by softening the lesion, changing its colour to lighter and slowing its growth.

Approximately 30 % of haemangiomas do not respond to corticosteroid treatment. Another risk is the reappearance of haemangiomas after treatment.

Surgical treatment is an option when conservative therapy fails.

So-called surgical excision involves the removal of the vascular body itself and the residual fatty tissue.

In children, surgery is postponed because it leaves scars and skin defects. An absolute indication for surgery in children is:

• a hemangioma located on the eyelid to prevent damage to vision
• occurrence in the scalp
• hemangioma in the genital area

Hemangiomas located inside organs are removed using endoscopic techniques.

Since the 1980s, laser has also been used. Laser is particularly successful for superficial lesions that do not exceed 8 mm in depth. Sometimes general anaesthesia is required during the procedure.

Cryotherapy (freezing treatment) is used for small haemangiomas that do not exceed 1.5 cm in diameter and 2 mm in depth.