Factores de riesgo para secuelas en Hemangiomas Infantiles.

Risk Factors for Sequelae After Involution of Infantile Hemangiomas

JAMA dermatology (Chicago, Ill.)

• IMPORTANCE

  Infantile hemangiomas involute to some extent, but they often leave sequelae that may cause disfigurement. Factors determining the risk of permanent sequelae after regression are of crucial importance in treatment decision making.

  OBJECTIVES

  To describe the sequelae left by infantile hemangiomas after natural involution and to identify clinical characteristics that could predict the most severe or a particular type of sequelae.

  DESIGN, SETTING, AND PARTICIPANTS

  Multicentric retrospective cohort study of images from 187 infantile hemangiomas that had not received systemic treatment and had follow-up pictures until regression that were selected from photographic files taken between 2003 and 2013 at 4 university hospitals with large vascular clinics in 3 different countries.

  MAIN OUTCOMES AND MEASURES

  Outcome measures were the type of sequelae classified as residual telangiectasia, anetodermal skin, redundant skin, persistent superficial component, and the degree of sequelae ranging from 1 to 4.

  RESULTS

  A total of 184 hemangiomas were included. The overall incidence of significant sequelae was 101 of 184 (54.9%). The most common sequelae after involution were telangiectasias (145, 84.3%), fibrofatty tissue (81, 47.1%), and anetodermic skin (56, 32.6%). The average age at which hemangioma completed involution was 3.5 years. Superficial and deep hemangiomas left significantly fewer sequelae than combined hemangiomas (Mann-Whitney; superficial vs deep, OR, 1.6; 95% CI, 0.6-3.8; P = .81; superficial vs combined, OR, 3.3; 95% CI, 1.7-6.3; P < .001; deep vs combined, OR, 2.1; 95% CI, 0.9-5.1; P < .001). Hemangiomas with a step or abrupt border of the superficial component left more severe sequelae than those with a smooth border (χ2,OR, 3.4; 95% CI, 1.8-6.6; P < .001). Superficial hemangiomas with a cobblestone appearance or rough surface left more severe sequelae than those with a smooth surface (Kruskal-Wallis; α, 0.05; P < .001). Using multivariate analysis, combined hemangiomas with a superficial component and a step border were associated with more sequelae.

  CONCLUSIONS AND RELEVANCE

  In this retrospective study of sequelae in a large cohort of untreated infants, we quantified the prevalence of permanent scarring and identified clinical features predictive of permanent sequelae. Our observations provide useful information at a time when the treatment paradigm for hemangiomas has changed. Such knowledge may help primary care physicians predict the risk of sequelae and identify high-risk lesions to implement early treatment.Article Citation

JAMA dermatology (Chicago, Ill.)

Risk Factors for Degree and Type of Sequelae After Involution of Untreated Hemangiomas of Infancy

JAMA Dermatol 2016 Aug 17;[EPub Ahead of Print], E Baselga, E Roe, J Coulie, FZ Muñoz, LM Boon, C McCuaig, A Hernandez-Martín, I Gich, L Puig 

TAKE-HOME MESSAGE

• This retrospective study reviews 185 cases of untreated infantile hemangiomas to identify features predictive of long-term sequelae. In these cases, the incidence of permanent sequelae considered significant to severe was 55%.

• The type of border was predictive of sequelae in hemangiomas with a superficial component (either superficial or combined), with step-off borders being most associated with long-term sequelae (found in 70.5% of cases compared with 41.3% of cases with smooth borders). 

  – Anna Wile, MD