Kim H J, Colombo M, Frieden I J
Division of Pediatric Dermatology, Children's Hospital of Philadelphia, PA 19104, USA.
J Am Acad Dermatol. 2001 Jun;44(6):962-72. doi: 10.1067/mjd.2001.112382.
Hemangiomas represent the most common benign tumor of infancy, with ulceration its most frequent complication.
Our purpose was to review our experience with this challenging problem by evaluating the clinical features, management, and therapeutic responses of ulcerated hemangiomas.
A retrospective analysis of ulcerated hemangiomas at the University of California, San Francisco outpatient pediatric dermatology clinics and Oakland Children's Hospital from 1987 to 1997 was performed.
The medical records of 60 patients were examined. Forty-nine female and 11 male patients were seen with a female/male ratio of 4.5:1. The majority of ulcerated hemangiomas were of the plaque type (n = 50; 83%) and relatively large; 47 (78%) were larger than 6 cm(2). The perineum was the single most frequently involved site, affected in 20 cases (33%). Topical antibiotics, barrier creams, and bio-occlusive dressings were used in most cases. Systemic antibiotics were used in 26 cases (43%) for overt or presumed infection. Systemic corticosteroids were used in 21 children (37%), 5 of whom did not show a response. Intralesional triamcinolone was used in 7 cases (12%), with 4 showing definite improvement. The flashlamp pulsed-dye laser was the modality used in 22 children (37%), 11 (50%) of whom showed definite improvement, 4 (18%) who showed no significant response, and 1 (5%) who showed definite worsening. Interferon alfa-2a was required in 5 patients (8%), all of whom showed improvement without appreciable neurologic side effects. Immediate surgical excision was required in only 2 cases (3%). Pain control with oral acetaminophen, acetaminophen with codeine, and topical 2.5% lidocaine ointment was effective in managing the pain of lip and perineal hemangiomas, with no side effects noted.
No one uniformly effective treatment modality was found, and frequently several were used concurrently. The decision to use specific therapies was dependent on the age of the patient, as well as the location, size, and stage of growth or involution of the hemangioma. Our approach to management included 4 major areas: local wound care, management of infection, specific therapeutic modalities (systemic and intralesional corticosteroids, flashlamp pulsed-dye laser, and interferon alfa-2a), and pain management.
血管瘤是婴儿期最常见的良性肿瘤,溃疡是其最常见的并发症。
我们的目的是通过评估溃疡型血管瘤的临床特征、治疗方法和治疗反应,来回顾我们处理这一具有挑战性问题的经验。
对1987年至1997年在加利福尼亚大学旧金山分校儿科门诊皮肤科诊所和奥克兰儿童医院的溃疡型血管瘤患者进行回顾性分析。
检查了60例患者的病历。其中女性49例,男性11例,男女比例为4.5:1。大多数溃疡型血管瘤为斑块型(n = 50;83%)且相对较大;47例(78%)面积大于6平方厘米。会阴部是最常受累的单一部位,20例(33%)受影响。大多数病例使用了局部抗生素、屏障乳膏和生物封闭敷料。26例(43%)因明显或疑似感染使用了全身抗生素。21例儿童(37%)使用了全身皮质类固醇,其中5例无反应。7例(12%)使用了瘤内注射曲安奈德,4例有明显改善。22例儿童(37%)使用了闪光灯脉冲染料激光,其中11例(50%)有明显改善,4例(18%)无明显反应,1例(5%)明显恶化。5例患者(8%)需要使用干扰素α-2a,所有患者均有改善且无明显神经副作用。仅2例(3%)需要立即手术切除。口服对乙酰氨基酚、含可待因的对乙酰氨基酚和局部使用2.5%利多卡因软膏控制唇部和会阴部血管瘤疼痛有效,未观察到副作用。
未发现一种统一有效的治疗方法,且通常同时使用多种方法。使用特定治疗方法的决定取决于患者年龄,以及血管瘤的位置、大小、生长或消退阶段。我们的治疗方法包括4个主要方面:局部伤口护理、感染管理、特定治疗方法(全身和瘤内皮质类固醇、闪光灯脉冲染料激光和干扰素α-2a)以及疼痛管理。