Diagnosis and Management of Infantile Hemangioma

Table 32. Adverse effects in case series of laser treatments for IH (continued)
Intervention
Harm/Adverse Event
Number of Studies
Reported Rates
(# Participants With
Across Studies
Harm/Total Participants)
Long-pulse
Hypopigmentation 236 1 (48) 2.1%
Alexandrite laser Blistering 236 1 99/48) 18.8%
Marked edema and erosion 1 (1/48) 2.1%
without residual scarring 236
Combination (Pulsed
Dye and ND:YAG)
Blistering 235 1 (17/37) 45.9%
Erosion 235 1 (1/37) 2.7%
Scarring 235 1 (1/37) 2.7%
CO2 = carbon dioxide; IH = infantile hemangioma; Nd:YAG = neodymium yttrium aluminum garnet
One study 227 noted “some” scarring. One study 231 reported complications of “delayed healing, infection and/or scar formation” in
16/160 (10%) of participants. One study 229 noted transient hypo- or hyperpigmentation in approximately 7% of cases and small
atrophic scars in 4%.
Table 33 outlines harms reported in surgical case series and in one comparative study of
cryosurgery. 220 Dehiscence rates ranged from 1.4 percent to 5.5 percent in five
studies, 238,240,246,248,251 and single cases of postoperative trauma-related wound dehiscence were
reported in an additional three studies. 238,241,243 Postoperative infections were noted in two
studies. 240,249 Scarring, skin necrosis, and alopecia were also noted in two reports. Other
complications including facial paresis, permanent palsy, hematoma, intraoperative bleeding,
cellulitis, hypopigmentation were reported in a single study each. One study reported no adverse
events. 247 One larger series of 127 patients with lip IH treated with liquid nitrogen cryotherapy
reported five cases of hypopigmentation and three cases of hemorrhage and ulceration. Labial
mucoceles were noted in three children 3 years after treatment. 244 Harms reported in one study of
cryosurgery included scarring in treated and untreated lesions. 220
Table 33. Adverse effects in case series of surgical treatments for IH
Intervention
Harm/Adverse Event
Number of Studies (#
Reported Rates
Participants With
Across Studies
Harm/Total Participants)
Surgery including Dehiscences 238,240,246,248,251 5 (17/357) 1.4%-5.5%
excision and Postoperative traumatic wound 3 (3/119) 2.3%-2.8%
resection
dehiscence 238,241,243
Wound infections minor or
1 (6/44) 13.6%
dehiscence 241
Postoperative infection 240,249 2 (1/264) 0-2%
Postoperative hematoma 245 1 (1/67) 1.5%
Intraoperative bleeding 249 1 (2/50) 4%
Skin necrosis 243,245 2 (3/106) 2.6%-3%
Hypertrophic scarring/cheloids 249,251 2 (10/142) 4%-9.8%
Incomplete excision with scarring 249 1 (1/50) 2%
Facial paresis, transient postop 239 1 (4/43) 9.3%
Permanent palsy of facial nerve 239 1 (1/43) 2.3%
Hemorrhage and ulceration 244 1 (3/127) 2.4%
Hypopigmentation of the skin or 1 (5/127) 3.9%
vermillion of the lip 244
Labial mucoceles observed 3 years 1 (3/127) 2.4%
post- surgery 244
Alopecia/Loss of small eyelash 2 (2/125) 1.1%-3%
segment 242,251
Cellulitis 251 1 (2/92) 2.2%
Functional impairment 251 1 (2/92) 2.2%
IH-infantile hemangioma
No complications were noted in one study. 247
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