Diagnosis and Management of Infantile Hemangioma

long term follow information was available. A fair quality case series reported on PDL treatment
for 65 children with ulcerated IH. 227 There were no cases of the predefined complications of
hypo- or hyperpigmentation or epidermal textural changes. Some scarring occurred in an
unknown number of patients that was comparable to scarring associated with healing of
conservative treatment. Another fair quality case series of hand hemangiomas noted atrophy,
pigment change, ulceration and scarring. 230 The most frequently reported harms were
hyperpigmentation (1% to 14% in four studies 221,223-225 ) and hypopigmentation (0-25% in five
studies 221,223-225,228 ). Ulceration was also noted in three studies. Two studies reported no adverse
events, 222,226 and another reported no permanent side effects but cases of hyper and
hypopigmentation. 225
One thousand and seven children received treatment with Nd:YAG lasers reported in four
case series. The most frequently reported adverse events from one large case series with 684
children included skin burn (11%), infection (6.6%), and scarring (4.4%). 232 Another larger study
with 160 participants reported complications including delayed healing, postoperative infection
and scarring in 10 percent of their patients. 231 A single case series of 31 patients with subglottic
IH noted one case of respiratory distress related to the ventilation system. 237
Table 32. Adverse effects in case series of laser treatments for IH
Number of Studies
Intervention
Harm/Adverse Event
(# Participants With Reported Rates
Harm/Total
Across Studies
Participants)
Pulsed dye laser Hyperpigmentation 221,223-225 4 (17/357) 1%-14.5%
Hypopigmentation 221,223-225,228 5 (192/1014) 0-25.1%
Pigment change (increase or 2 (67/700) 7-9.7%
decrease) 228,230
Ulceration 224,228,230 3 (7/790) 0.76-2.3%
Blisters 221 1 (3/62) 4.8%
Atrophy 228,230 2 (50/700) 7%-7.15%
Scarring 228,230 2 (7/700) 0.9%-2.3%
Granuloma telangiectaticum 229 1 (4/548) 0.7%
Cutaneous atrophy and
1 (22/657) 3.4%
pigmentation 228
Cutaneous atrophy and
1 (32/657) 4.9%
hypopigmentation 228
Nd:YAG laser Scarring 232,234 2 (36/794) 4.4%-5.5%
Hypertrophic scarring 234 1 (2/110) 1.8%
Ulceration 232 1 (15/684) 2.2%
Skin burn 232 1 (75/684) 11%
Bleeding 232,234 2 (13/794) 0.9%-1.8%
Nerve injury 232 1 (9/684) 1.3%
Infection 232 1 (45/684) 6.6%
Undesirable texture change 232 1 (30/684) 4.4%
Anemia and hyperkalemia 232 1 (1/684) 0.15%
Postoperative stenosis 233 1 (1/53) 1.9%
CO2 laser Respiratory distress 237 1 (1/31) 3.2%
Subglottic scarring 237 1 (1/31) 3.2%
76