HAEMANGIOMAS IN CHILDREN
A mother’s joy is “marked” when once she has had her baby she looks at it and although it is healthy it had the misfortune to be born with a red mark.
All these mothers, before they can say “thank you” to several “congratulations” wishes, unnecessarily feel they have to apologize for this mark of the nature. Other people’s mercy and comforting words heard by relatives and friends are a very hard plight that gradually turns into a daily nightmare.
Both port-wine stains (PWS) and true haemangiomas are quite common among newborns and babies. The exact distinction between these two types of vascular lesions is of great importance due to their differences regarding pathophysiology and progress. Examination by a specialised dermatologist is necessary to achieve an accurate diagnosis, so that to choose the right treatment method of either the haemangioma or the PWS with the best possible way.
Port Wine Stains (PWS) are always present at birth, they are not getting better if no treatment is followed and, as a result, any anticipation for regression over time is futile. To the contrary, the majority of PWS become darker in colour and sometimes superficial lumps may develop after age 25 to 30 years. PWS occur in 0.3% of newborns and in 80% of the cases they appear on the face.
In certain cases that PWS remain untreated they lead to the development of hypertrophy- swelling in the affected area, such as the lower lip of the mouth, the hands or feet. Therefore, treatment in a timely manner is very important, both because the treatment is accomplished in a shorter time and with greater success in terms of lesion regression, but also because the strong psychological burden of the child at school age is avoided.
Superficial true haemangiomas or “strawberry” haemangiomas, as they are sometimes called due to their appearance, are big or small skin lesions, which occur from birth or shortly after that. They are benign growths of the vascular components of the skin, consisting of a larger number of expanded vessels. “Strawberry” haemangiomas should be treated immediately, during the first months of a baby’s life, especially in cases that normal processes of the organism are obstructed (e.g. vision and/or breathing), when they lead to complications, such as ulceration, infection and/or bleeding and when they occur in aesthetically important areas, like the face.
Even in cases that there is no medically important reason to immediately treat a vascular lesion; both PWS and haemangiomas are aesthetically annoying, as the majority of them occur on the face. In addition to this, they may be also responsible for other problems, mainly psychological, due to their unsightly appearance.
Children in many cases hear negative comments from their peers, while the parents are offended and feel inferior to others. This may influence interpersonal and social relations of the child when entering primary education. In some countries abroad, such as the United Kingdom and the United States organisations have been establish, the members of which are people with PWS and haemangiomas.
Another common phenomenon is misdiagnosis of the vascular lesion, i.e. providing a diagnosis of a PWS while the lesion is actually a haemangioma or the other way round. This may result in following the wrong treatment method, which is not effective. Therefore, successful treatment of vascular lesions, PWS and true haemangiomas, is not only essential from a social point of view but also necessary from a medical point of view.
In particular, as far as PWS are concerned, according to international literature the golden rule for their treatment is long-pulse Pulsed Dye Lasers (PDL), since these vascular lesions show no regression over time but they are actually getting larger with darker colour and superficial lumps. The mechanism of action of the pulsed dye laser is based on the theory of selective photothermolysis. The target of PWS treatment with the use of PDLs is the selective absorption of the applied laser wavelength from the skin tissue and satisfactory penetration with sufficient energy to destroy the problematic vessels without affecting the surrounding healthy tissues.
For the treatment of superficial true haemangiomas the best result is possible through the combined used of a drug called propranolol and the application of long-pulsed PDL. With the use of this particular laser device it is possible to achieve excellent results through the destruction of enlarged vessels. Essentially, with the combination of these two therapeutic interventions when appropriate it is possible to achieve quicker and more complete regression of congenital true haemangiomas. At the same time, the total dose of administered propranolol is reduced, which is also important.
In conclusion it could be said that with early treatment through the use of PDL, which is being applied for fifteen years now in Greece by the specialised dermatologist Dr Christopher Tzermia, it is possible to achieve treatment even in 2-week old babies. Early initiation of treatment allows the limitation of risks and the prevention of possible complications related to the development of the vascular lesion. At the same time, both paediatric patients and their parents feel psychological relief during their first years of life with higher success rates as compared to later initiation of treatment.