Search Results (43)

Background: An infantile hemangioma (IH) is a benign lesion that develops as a result of pathologically dysregulated proliferation of the endothelial cells of the capillaries, typically appearing within the first three years of life. The disease is found mostly on the skin and—less often—in the internal organs. Although IH generally has a good prognosis and may sometimes undergo spontaneous regression, certain types of IH with a specific form, localization, and size may lead to life-threatening conditions including impairment of vital functions. This determines the need for precise diagnostics and treatment. Case presentation: The paper presents a clinical observation of an infant in the first months of life with IH presenting as diffuse hepatic hemangiomatosis and a hemangioma of the left eyebrow area. The IH was associated with life-threatening conditions. However, effective treatment with the non-selective β-adrenoblocker propranolol led to a positive outcome and the resolution of complications. Conclusions: This case demonstrates the critical importance of timely diagnosis and treatment for lesions that, while benign, can lead to fatal complications if not addressed promptly. Full article

Background: Infantile hepatic hemangiomas (IHH) are common benign vascular tumors in infancy with diverse presentations. Methods: We report a 7-week-old infant presenting with hepatosplenomegaly, multiple skin and hepatic hemangiomas, anemia, and recurrent lung infections. Results: Treatment included propranolol, corticosteroids, and sirolimus, along with antifungal prophylaxis with fluconazole. The patient developed pneumothorax and pulmonary aspergillosis. Despite antifungal therapy with voriconazole and liposomal amphotericin B, along with surgical intervention, her condition deteriorated, resulting in multi-organ failure and death at 8.5 months of age. Conclusions: This case illustrates the complexity of IHH management and highlights the risk of severe infections during immunosuppressive therapy even when standard prophylaxis protocols are applied. Full article

Introduction: Artificial intelligence (AI) has developed into an increasingly important tool in dermatology. While new technologies integrated within laser devices are emerging, there is a lack of data on the applicability of publicly available AI models. Methods: The prospective study used an online questionnaire where participants evaluated diagnosis and treatment for 25 dermatological cases shown as pictures. The same questions were given to AI models: ChatGPT-4o, Claude Sonnet 4, Gemini 2.5 Flash, and Grok-3. Results: Dermatologists outperformed AI in diagnostic accuracy (suspected primary diagnosis-SD 75.6%) in pooled dermatologists vs. pooled AI (SD 57.0%), with laser specialists achieving the highest accuracy (SD 82.0%) and residents the lowest (SD 66.0%). There was a high heterogeneity across AI models. Gemini approached dermatologist performance (SD 72.0%), while Claude showed a low accuracy (SD 40.0%). While AI models reached near 100% accuracy in some classic/common diagnoses (e.g., acne, rosacea, spider angioma, infantile hemangioma), their accuracy dropped to near 0% on rare or context-dependent cases (e.g., blue rubber bleb nevus syndrome, angiosarcoma, hirsutism, cutaneous siderosis). Inter-rater agreement was high among laser experts in terms of diagnostic accuracy and treatment choice. Agreement between residents and AI models was highest for diagnostic accuracy and treatment choice, while it was lowest between experts and AI models. Conclusions: Before AI-based tools can be integrated into daily practice, particularly regarding diagnosis and appropriate laser treatment recommendations, specific supervised medical training of the AI model is necessary, as open-source platforms currently lack the ability to contextualize presented data. Full article

Background: This study aimed to explore the key factors affecting the efficacy of local bleomycin injection by quantitatively analyzing the blood flow parameters of lesions before treatment using three-dimensional color power angiography to allow early prediction of the treatment response in patients with infantile hemangioma. Methods: The clinical data of children diagnosed with infantile hemangioma and treated with locally injected bleomycin at the Children’s Hospital of Chongqing Medical University between February 2018 and October 2024 were retrospectively analyzed. The treatment efficacy grades of the included patients were determined. Baseline clinical information and the three-dimensional blood flow parameters (the vascularization index, flow index, and vascularization–flow index) were collected and compared with the treatment response. The predictive ability of the identified indicators was evaluated using receiver operating characteristic curves. Results: Of the 40 patients included in the study, 13, 16, 8, and 3 had treatment efficacy grade I, II, III, and IV lesions, respectively. There were no significant differences in age or lesion location, type, or volume before treatment among lesions of different treatment efficacy grades (p > 0.05). The vascularization index, flow index, and vascularization–flow index were significantly higher in grade I lesions than in those of the other three groups (p < 0.001, p = 0.008, and p = 0.003, respectively), and these indices decreased as the efficacy grade increased. The vascularization–flow index was identified as an independent predictor of treatment efficacy, with a sensitivity of 81.5%, a specificity of 84.6%, and an area under the receiver operating characteristic curve of 0.85 at the optimal cutoff value of 23.3. Conclusions: The vascularization–flow index can be used as an objective predictor of the response of infantile hemangioma to locally injected bleomycin. It is recommended that patients with a vascularization–flow index <23.3 receive locally injected bleomycin, and those with a vascularization–flow index ≥23.3 should receive an alternative treatment option. Full article

Purpose: The recurrence rate and related risk factors of infantile hemangiomas after treatment discontinuation remain concerns. We aim to evaluate the risk of recurrence after termination of oral propranolol for IHs and its associated risk factors. Methods: The Embase, PubMed, Web of Science, and Cochrane Central databases and clinicaltrials.gov were searched comprehensively for relevant studies from the inception of this study to November, 2024. Two independent reviewers conducted the data extraction and quality assessment. This review protocol was registered in the PROSPERO database (CRD42024589110). Results: A total of 1662 patients in 10 studies met the eligibility criteria, which was predominantly retrospective in design. All participants were infants diagnosed with infantile hemangiomas who received oral propranolol therapy; the majority of patients received propranolol treatment for at least six months. The results revealed that the pooled recurrence rate was 20% (95% CI: 15–24%), and 11% of patients required retreatment with propranolol (95% CI: 9–14%). Female sex (OR = 1.76, 95% CI: 1.20–2.59) and IHs located on the head and neck (OR = 2.40, 95% CI 1.59–3.63) increased the risk of recurrence. In contrast, IH type, lesion distribution, duration of therapy, and treatment initiation age showed no significant associations. Additionally, one trial included in this review reported that continued medication for one month after the lesion reaches its maximum degree of regression might increase the risk of recurrence as compared to three months of maintenance (OR = 1.86, 95% CI 0.98–3.5); however, the evidence is limited and preliminary. Conclusions: Female sex and IHs located on the neck or head contribute to the recurrence of IHs after termination of treatment. In addition, the type of IH and withdrawal criteria may influence recurrence risk, although evidence remains limited. Thus, optimizing treatment protocols, including individualized therapy duration and discontinuation strategies, may help reduce recurrence rates. Full article

Background: Hemangiomatosis is a rare condition characterized by the presence of multiple benign vascular tumors that may affect various organs, including the skin, liver, and spleen. Complications are closely linked to the location and size of the lesions. Case Presentation: We describe a rare presentation of infantile hemangiomatosis with widespread cutaneous and oral mucosal lesions, further complicated by splenic and hepatic involvement and secondary cholestasis. The initial progression was unfavorable, with an increase in both the number and size of the lesions. Cardiologic evaluation identified minor valvular insufficiencies, but no secondary cardiac failure. Treatment with propranolol and prednisone was initiated, with a slow favorable evolution. There were no new hemangiomas developed, and those on the face and limbs decreased in size, some disappearing entirely. Hepatic and splenic hemangiomas regressed more slowly, but their reduction and the improvement of cholestasis were progressive. Due to significant iatrogenic Cushing’s syndrome, prednisone was gradually tapered. Transient subclinical hypothyroidism occurred during treatment, resolving spontaneously. Conclusions: The present case illustrates the rarity and complexity of multifocal infantile haemangiomatosis and highlights the importance of early diagnosis, comprehensive organ evaluation, and tailored multidisciplinary management. It clearly demonstrates that prompt intervention and careful therapy adjustment can lead to favorable outcomes even in the setting of extensive visceral involvement. Full article

The incidence and mortality of colorectal cancer (CRC) have increased globally. Several therapeutic approaches have been suggested to address this health issue, in addition to classical methods. Propranolol (PRO) is a beta-blocker that was repurposed to treat infantile hemangiomas, and its anti-tumor activity has been reported. This study aimed to investigate the effects of PRO in a panel of CRC cell lines and its potential impact when combined with chemotherapy. The effects of PRO on cell cytotoxicity, cell morphology, colony formation, cell death induction, cell cycle, mitochondrial and intracellular reactive oxygen species (ROS), and migration were measured in all cells. CompuSyn software was utilized to assess the possible synergistic or additive interaction in the combined treatment. The results showed that PRO suppressed cell proliferation, altered cell morphology, inhibited colony formation, induced apoptosis, altered cell cycle and ROS generation, and inhibited the migration of treated cells in a cell-type-specific, time-dependent, and dose-dependent manner compared with the control. HT-29 was the most sensitive cell line to PRO in terms of cytotoxicity, apoptosis, cell cycle arrest, and ROS generation, while SW-480 was the most sensitive in terms of migration inhibition. Moreover, the PRO and capecitabine combination exhibited a synergistic effect and induced mitochondrial apoptosis in metastatic CRC cells. The data suggest that PRO could be a promising adjuvant therapy for primary and advanced CRC. This study identified variations between CRC cell lines in response to PRO, which may be related to their genetic and epigenetic differences. In addition, the findings highlight the potential of combination strategies to improve therapeutic outcomes in metastatic CRC. Full article

Background/Objectives: Infantile hemangioma (IH) is a common vascular tumor in neonates, influenced by multiple prenatal and perinatal factors. This study aimed to identify risk factors in both infants and mothers, assess their link to clinical characteristics and severity, and evaluate treatment outcomes when systemic propranolol therapy was administered. Methods: We conducted a retrospective observational study analyzing 43 infants under 12 months, including 11 neonates (<28 days) diagnosed with IH. Maternal and neonatal factors, diagnostic timelines, clinical presentation, and treatment efficacy were examined. Data analysis included descriptive statistics, focusing on gestational age, birth weight, Apgar scores, and the Infantile Hemangioma Referral Score (IHReS). Results: The study found a female predominance and a correlation between IH and pre-term birth (50%) and low birth weight (<2760 g, 51.16%). Maternal anemia (23%) and gestational hypertension (9%) were present in the cohort, but no statistical association with IH severity was found. A significant number (44.18%) were diagnosed within the first two weeks postpartum. The IHReS was inversely correlated with Apgar scores, with newborns scoring above 8 having a lower IHReS. Treatment with propranolol (1–3 mg/kg/day) was highly effective, resulting in significant lesion regression in most patients. Mild complications included sleep disturbances (12%) and diarrhea (9%). The most affected areas were the face/eyelid (32.55%), limbs (18.6%), and anterior thorax. Additionally, 42% of cases had an IHReS above 4, with multiple hemangiomas increasing severity. Conclusions: IH was common in pre-term and low-birth-weight infants, whereas the maternal comorbidities observed in this small cohort did not show a definitive association, underscoring the need for controlled studies. Early diagnosis, risk stratification, and timely propranolol therapy are crucial in achieving favorable outcomes. Further research is needed to assess long-term effects and evaluate risks of treatment rebound. Full article

Objective: To explore the role and mechanism of miR-27b-3p in treating infantile hemangiomas (IHs) with propranolol and to clarify the cause of the poor efficacy of propranolol in IHs. Methods: Human umbilical vein endothelial cells (HUVECs) were used as the research model and were treated with 0, 15, 30, 45, 60, and 90 μM of propranolol to explore the best concentration. RNA interference technology was used to regulate the expression of miR-27b-3p. CCK-8, TUNEL, and flow cytometry detected cell proliferation and apoptosis levels. Real-time PCR was used to detect the expression of miR-27b-3p and apoptosis pathway-related mRNA, and Western blotting was used to detect the expression of apoptosis-related proteins. The target relationship between miR-27b-3p and Apaf-1 was analyzed using a double Luciferase report. Results: The most significant inhibitory effect on cell activity of propranolol is at a dose of 30 μM. After propranolol treatment, the expression of miR-27b-3p was downregulated, and the expression of the apoptotic factors Apaf-1, PARP, caspase-9, and caspase-3 was upregulated, which was consistent with the results after the deletion of miR-27b-3p. However, after upregulation of miR-27b-3p, the level of and the expression of apoptotic factors was inhibited. “targetscan.org” gene database analysis found that miR-27b-3p matched the 3′-UTR of Apaf-1 mRNA, and luciferase results showed that miR-27b-3p had a targeted relationship with Apaf-1. Conclusions: The miR-27b-3p target inhibits the expression of Apaf-1, reduces the level of endothelial cell apoptosis, and interferes with the therapeutic effect of propranolol. Full article

Infantile hemangioma (IH) is the most common pediatric benign vascular tumor. Its pathogenesis is still poorly understood, and it usually appears during the first few weeks of life and follows a characteristic natural course of proliferation and involution. Most IHs are small, benign, resolve spontaneously, and do not require active treatment but only active observation. A minority of IHs are potentially problematic because they can cause life-threatening complications, permanent disfigurement, and functional impairment. Diagnosis is usually clinical, and propranolol is currently the mainstay of treatment. Other therapeutic modalities may be used alone or in combination, depending on the characteristics of the specific IH. New treatment options are being explored every day, and some are showing promising results. It is undeniable that therapeutic modalities for IHs must be selected based on the child’s age, the size and location of the lesion, the presence of complications, the implementation conditions, and the possible outcomes of the treatment. The future of IH management will certainly be reflected in improved advanced imaging modalities, research into the genetic and molecular basis, the development of new pharmacological agents or techniques, and the development of standardized protocols, all to optimize outcomes with minimal side effects. Full article

Background/Objectives: Since 2008, following clinical studies conducted on children that revealed the ability of the β-adrenergic antagonist propranolol to inhibit capillary growth in infantile hemangiomas (IHs), its oral administration has become the first-line treatment for IHs. Although oral propranolol therapy at a dosage of 3 mg/kg/die is effective, it can cause systemic adverse reactions. This therapy is not necessarily applicable to all patients. Topical skin applications could help maintain a high drug concentration at local sites and also represent a characteristically easy method of administration for pediatric patients. Because no topical propranolol dosage forms are commercially available, such formulations may be prepared at hospitals and pharmacies. Methods: In the present study, we identified a simple method for preparing topical propranolol hydrochloride formulations at 1% w/w with five commercial ready-to-use bases and evaluated the pharmaceutical profiles. The physical stability of the extemporaneous formulations was predicted by performing an accelerated centrifuge test and assessed by visual inspection after one month storage at 25 °C. The chemical stability of the drug in the five formulations was assessed by using a high-performance liquid chromatography (HPLC) method. In vitro drug-release and permeability experiments were conducted through synthetic membranes and the outer pavilion of a pig’s ear by utilizing Franz-type diffusion cells. Results: The results indicated that the release of the drug was significantly influenced by the internal structure and physicochemical properties of each base. Conclusions: Specifically, the formulations prepared with the hydrophilic bases could be easily prepared and yield satisfactory results, representing a potential effective therapy for IHs in pediatric patients. Full article

Introduction and Aim: Propranolol is an effective treatment option for infantile hemangiomas, but there is still insufficient information about neurodevelopmental side effects of propranolol. In our study, the neurodevelopmental levels of infantile hemangioma patients receiving propranolol treatment were examined using the Bayley-III test. Method: In our single-center, cross-sectional study, patients were recruited between 1 January 2020 and 31 December 2023. In total, 40 children (n1) diagnosed with hemangioma who received propranolol treatment and 31 children (n2) who were only under observation were included. A control group of 31 healthy children (n3) matched for age and gender was also included. The demographic, clinical, perinatal, and postnatal characteristics of the total 102 children were recorded from their medical records. Neurodevelopmental levels were assessed with the Bayley-III test. The significance level was set at (p < 0.05). Results: The Bayley-III test composite and percentile scores were used to evaluate the neurodevelopmental levels. Significant differences in motor functions were found between the treated and untreated groups compared to the healthy control group (p = 0.006 and p = 0.006). However, no significant differences were found in cognitive, language, and social-emotional skills. Cognitive, language, and motor functions were associated with maternal education level, and additionally, cognitive functions were also associated with paternal education level. Conclusions: Propranolol has a relatively safer side effect profile, and therefore, it has been described as a safe agent. In our study, no significant effect of propranolol on neurodevelopment was observed. The difference in motor skills shown was mainly between the healthy control group (n3) and the treated and untreated group (n1 and n2), which led to the conclusion that the relevant difference could be due to factors other than propranolol itself. Full article

Infantile haemangiomas (IHs) affect 3–10% of infants, 10% of whom need topical or systemic beta-blocker therapy. Propranolol is the first choice for IHs with a high risk of complications. Since more than half of IHs leave a permanent mark, to reduce outcomes, it is essential to start oral propranolol (2–3 mg/kg/day in 2 doses/day) within the 5th month of life (i.e., during the proliferative phase) and to complete the therapy cycle for at least 6 months. This review aims to summarise the epidemiology, clinical presentation, diagnosis, and treatment of IHs and to highlight the importance of proper referral to specialised hub centres. Patients with vascular anomalies, particularly those suspected of having IH, should be referred to a specialised centre for accurate diagnosis, management by a multidisciplinary team, and timely treatment. IHs may pose life-threatening, functional, and aesthetic risks or may ulcerate. Segmental infantile haemangioma of the face/neck and the lumbosacral regions can be associated with various malformations. To ensure timely specialist evaluation and treatment to reduce the potential risk of complications, it is essential to identify high-risk IHs rapidly. The Infantile Haemangioma Referral Score (IHReS) scale is an important tool to assist primary care paediatricians and general dermatologists. Full article

Infantile hemangioma (IH) is a vascular anomaly observed in newborns, with potential severe complications if left undetected. Consequently, researchers have turned to artificial intelligence (AI) and digital imaging (DI) methods for detection, segmentation, and assessing the treatment response in IH cases. This paper conducts a systematic literature review (SLR) following the Kitchenham framework to scrutinize the utilization of AI and digital imaging techniques in IH applications. A total of 21 research articles spanning from 2014 to April 2024 were carefully selected and analyzed to address four key research questions: the issues solved in IH using AI and DI, the most-used AI and DI techniques, the best-performing technique in detecting IH, and the limitations and future directions in the various fields of IH. After an extensive review of the selected articles, it was found that 10 of the 21 articles focused on detecting IH, and 15 articles utilized AI. However, the best-performing technique in detecting IH employed DI. Additionally, the SLR offers insights and recommendations into future directions for IH applications. Full article

Infantile hemangiomas (IHs) are benign vascular neoplasms of childhood (prevalence 5–10%) due to the abnormal proliferation of endothelial cells. IHs are characterized by a peculiar natural life cycle enclosing three phases: proliferative (≤12 months), involuting (≥13 months), and involuted (up to 4–7 years). The mechanisms underlying this neoplastic disease still remain uncovered. Twenty-seven IH tissue specimens (15 proliferative and 12 involuting) were subjected to hematoxylin and eosin staining and a panel of diagnostic markers by immunohistochemistry. WT1, nestin, CD133, and CD26 were also analyzed. Moreover, CD31^pos/CD26^pos proliferative hemangioma–derived endothelial cells (Hem-ECs) were freshly isolated, exposed to vildagliptin (a DPP-IV/CD26 inhibitor), and tested for cell survival and proliferation by MTT assay, FACS analysis, and Western blot assay. All IHs displayed positive CD31, GLUT1, WT1, and nestin immunostaining but were negative for D2-40. Increased endothelial cell proliferation in IH samples was documented by ki67 labeling. All endothelia of proliferative IHs were positive for CD26 (100%), while only 10 expressed CD133 (66.6%). Surprisingly, seven involuting IH samples (58.3%) exhibited coexisting proliferative and involuting aspects in the same hemangiomatous lesion. Importantly, proliferative areas were characterized by CD26 immunolabeling, at variance from involuting sites that were always CD26 negative. Finally, in vitro DPP-IV pharmacological inhibition by vildagliptin significantly reduced Hem-ECs proliferation through the modulation of ki67 and induced cell cycle arrest associated with the upregulation of p21 protein expression. Taken together, our findings suggest that CD26 might represent a reliable biomarker to detect proliferative sites and unveil non-regressive IHs after a 12-month life cycle. Full article