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婴幼儿血管瘤:皮肤科医生的视角。

Infantile hemangiomas: a dermatologist's perspective.

机构信息

Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

出版信息

Eur J Pediatr. 2024 Oct;183(10):4159-4168. doi: 10.1007/s00431-024-05655-8. Epub 2024 Jul 25.

Abstract

Infantile hemangioma (IH), the most common vascular tumor in pediatrics, is thought to arise from aberrant stem cell responses to stimuli such as hypoxia. This review explores the diverse manifestations, complications, and management strategies for IH, emphasizing the importance of a multidisciplinary approach. The epidemiology and risk factors associated with IH, including connections to prematurity, low birth weight, and family background, are discussed. The intricate pathogenesis involving hemangioma stem cells, KIAA1429, hypoxia, and the renin-angiotensin system is examined. The natural history and clinical features, as well as extracutaneous involvements such as hepatic IH, PHACES syndrome, and LUMBAR syndrome, are detailed. Complications such as ulceration, functional impairment, hypothyroidism, and cosmetic concerns are highlighted. The differential diagnosis and diagnostic modalities, including colorimeters, high-frequency ultrasonography, and imaging techniques, are discussed. Management approaches, including the use of propranolol, atenolol, corticosteroids, alternative systemic treatments, topical therapy, laser therapy, and surgery, are comprehensively reviewed. The evolving landscape of IH management is underscored, with ongoing research exploring alternative treatments and individualized approaches based on IH characteristics.

摘要

婴儿血管瘤(IH),儿科最常见的血管肿瘤,被认为是由于异常干细胞对缺氧等刺激的反应而产生的。本综述探讨了 IH 的多种表现、并发症和管理策略,强调了多学科方法的重要性。讨论了与 IH 相关的流行病学和风险因素,包括与早产、低出生体重和家族背景的联系。研究了涉及血管瘤干细胞、KIAA1429、缺氧和肾素-血管紧张素系统的复杂发病机制。详细描述了其自然史和临床特征,以及肝 IH、PHACES 综合征和 LUMBAR 综合征等皮肤外受累情况。强调了溃疡、功能障碍、甲状腺功能减退和美容问题等并发症。讨论了鉴别诊断和诊断方式,包括比色计、高频超声和成像技术。全面回顾了管理方法,包括使用普萘洛尔、阿替洛尔、皮质类固醇、替代全身治疗、局部治疗、激光治疗和手术。强调了 IH 管理的不断发展,正在探索基于 IH 特征的替代治疗和个体化方法。

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