Diagnosis and Management of Infantile Hemangioma

229,230
four studies of Nd:YAG lasers, 231-234 one of combined PDL and Nd:YAG, 235 one of longpulse
Alexandrite laser, 236 and one report of carbon dioxide laser. 237 Most studies included
children with IH in multiple locations; one included children with only airway IH. 237 Ages of
children in these series, where clearly reported, ranged from less than 1 month to 11 years. We
considered one study to be of good quality for harms reporting, 223 two of fair quality, 227,230 and
14 of poor quality. 221,222,224-226,228,229,231-237 We rated one cohort study that compared propranolol
with concurrent PDL or followed by PDL and two comparing laser and topical timolol as poor
quality for harms reporting and discuss harms of PDL here and harms of propranolol in the betablocker
section of KQ2 above. 14,106,150
Thirteen case series (840 children) reported harms from surgical procedures, typically
excision or resection, to treat IH. 238-249 Ages ranged from 1 month to 19 years. The majority of
studies focused on treatment of facial IH, including three studies of lip IH, 240,244,248 two series of
periocular/periorbital IH, 242,245 two reports of various facial locations, 241,247 and one study of
nasal tip IH. 243 All of the studies were rated as poor quality for assessment of harms as data
collection was not predefined.
Detailed Analysis
Effectiveness of Laser Treatment
PDL Compared With Observation
Two RCTs compared PDL to observation. One good quality RCT 210 randomized 22 children
with IH between 0 and 6 months of age into equal groups of observation or PDL with epidermal
cooling. Twelve-month size change scores were used for analysis. Further, parents were asked to
answer quality of life questionnaires at enrollment and at age 12 months. There was no statistical
difference seen in echo depth or total surface area between the two groups; however color was
significantly improved in the PDL group compared with control (p=0.03). Photographs reviewed
for overall improvement also showed a “significant improvement” for the PDL group (46%) over
the observation group (18%), but this “significant improvement” was not quantitatively defined.
Parent-reported quality of life scales showed no difference in the severity of skin problems
between groups. Sixty-three percent of parents in the PDL group reported improvement in the IH
at 12 months compared with 33 percent in the observation group (p=NR). Thirteen percent of
parents perceived the treatments to be very painful.
The second, fair-quality RCT randomized 121 children to PDL (n=60) and observation
(n=61) groups. 212,250 The investigators attempted to reduce bias by including a blinded panel of
parents of non-study children to describe whether they perceived the hemangioma to be a
problem at 1 year of age. The investigators reported no differences in the number of children
experiencing near complete resolution (42%-44% in each group) but more children in the PDL
group (30%) than in the control arm (5%) experienced complete resolution (p=0.001). Outcomes
between groups were similar at the 5-year followup of 117 children (32 of 57 in the PDL arm
had complete clearance vs. 27 of 60 in the observation arm, p=0.31 and 41 of 57 and 48 of 60
had minimal residual signs, p=0.39). Table 25 outlines key outcomes.
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