Hemangiomae

The term hemangioma is used to refer to a common type of vascular birthmark. The classically recognized hemangioma is a visible red skin lesion that may be superficial, deeper in the skin, or a mixture of both. Hemangiomas are not always present at birth (around 30%), but usually become visible within a few months (70%). They are usually divided into superficial, slightly raised, bright red lesions known as a capillary or 'strawberry' hemangioma or a deeper bluish lesion known as a cavernous hemangioma.

What Is It?

Capillary hemangiomas are usually slightly raised and appear bright red because the abnormal blood vessels are very close to the skin's surface. Cavernous hemangioma appear blue because the abnormal vessels are deeper under the skin. Hemangiomas are more common among females and in premature babies.

Most hemangiomas undergo a rapid growth phase once they first appear during which their volume and size increase rapidly. After the first year most stop growing and enter a rest period during which the hemangioma changes very little. Often they will then begin to turn white and shrink slowly. Many will eventually disappear by themselves although it impossible to know in individual patients if this will occur.

Hemangiomas can develop anywhere on the body, although 83% of them occur on the head and neck. Because of this the most common issue with hemangiomas is that they can be very disfiguring and it is frequently very difficult for most sufferers (and parents if they are children) to cope with the stares and comments that such lesions cause. There can be additional concerns if hemangioma develop near the eyes, nose or mouth because they can cause special problems. Occasionally when a hemangioma is either growing or shrinking rapidly they can form painful ulcers which can become infected.

Tradititional Treatments

Often many dermatologists will not treat strawberry hemangiomas instead allowing them to fade and shrink on their own. During the rapid growth phase steroids can be helpful in reducing the thickness of the hemangioma but they will not affect the redness.

Deep hemangiomas or compound hemangiomas (hemangiomas that have both superficial and deep parts) can be treated a number of ways.

If the area is fairly small and not on the face, injection of the lesion with steroids can be used. Larger hemangiomas however will require oral steroids and a fairly large dose is needed.

Where hemangiomas do not respond to steroids, are problematic or life-threatening, alfa-interferon is recommended. However spastic dysplegia has been associated in 10-12% of children who have taken alfa-interferon and so it should be used with caution.

Conventional surgery is indicated for hemangiomas that are life threatening, deforming or do not respond to treatment. For facial hemangiomas with no significant reduction in size between 2 and 3 years of age, surgical intervention should be considered. Surgery may also be indicated for hemangiomas that have been left alone and do not show signs of shrinkage after a few years.

Other treatments include Cryosurgery (where the vascular marks are frozen with an extremely cold substance sprayed onto the skin) or by Electrodesiccation (where the affected vessels are destroyed with the current from an electric needle).

Fotona Laser Treatment

Most hemangiomas when first diagnosed are superficial only. These can be treated with a laser as soon as they are diagnosed, and early treatment is key. The laser wavelength is absorbed by the oxyhemoglobin (the protein molecules that make blood red) in the blood vessels of hemangioma resulting in the shrinking of the vessels so that the result is a less noticeable lesion. Repeated treatments can almost completely remove superficial hemangiomas.

Since the blood vessels of cavenous hemangiomas are much deeper below the surface of the skin than superficial ones is necessary to use a laser that can penetrate much deeper to selectively target the vessels of the lesion without causing damage to the surrounding tissue.

Fotona's DualisVP combines a KTP laser with a long pulse Nd:YAG laser offers the perfect solution to vascular lesions such as hemangiomas. The KTP laser emits a green laser at a wavelength that is absorbed in oxyhemoglobin in order to treat superficial hemangiomas effectively. The long pulse Nd:YAG laser penetrates to a depth of 5-6mm into the skin allowing the effective treatment of cavenous hemangiomas. Independent research shows that over 75% of patients with deep hemangiomas that are treated with the Nd:YAG laser see a dramatic regression in the lesion.

Before & After

BEFORE	AFTER