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By John P. Bunker, Benjamin A. Barnes, Frederick Mosteller

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Clin Plast Surg 38:31-44, 2011. Horii KA, Drolet BA, Frieden IJ, Baselga E, Chamlin SL, Haggstrom AN, Holland KE, Mancini AJ, McCuaig CC, Metry DW, Morel KD, Newell BD, Nopper AJ, Powell J, Garzon MC. Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas. Pediatr Dermatol 28:245-253, 2011. Huang SA, Tu HM, Harney JW,Venihaki M, Butte AJ, Kozakewich HP, Fishman SJ, Larsen PR. Severe hypothyroidism caused by type 3 iodothyronine deiodinase in infantile hemangiomas.

Indd 34 6/4/2013 3:15:58 PM Chapter 3 • Infantile Hemangioma 35 orbital area. Although lightening of the skin may occur, if an underlying mass is present, it will not be affected. Adverse effects include hypopigmentation and skin atrophy. Topical Timolol  Topical timolol may be effective for small, superficial infantile hemangiomas in unfavorable locations, such as the periorbital area, lip, or nose. The drug does not penetrate through the dermis, and thus deep tumors are not affected. 5% gel-forming solution (5 mg/ml) applied twice daily may prevent proliferation and cause accelerated regression.

Patients typically have a cardiology consultation (75%) and undergo an electrocardiogram (81%), echocardiogram (38%), glucose/electrolyte measurements, and frequent blood pressure, heart rate, and respiratory examinations. Children with airway disease, those born prematurely, or infants less than 3 months of age often undergo inpatient initiation of drug treatment. Potential contraindications include asthma or reactive airway disease, glucose abnormalities, congenital heart disease, hypotension, bradycardia, or cerebrovascular malformations (PHACES association).

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