Medication Summary

No medications, other than those used for initial treatment, are needed. For patients with an asymptomatic oral vascular malformation that is stable, nonprogressive, and that has no functional impairment or bleeding, observation is indicated. Painful perioral hemangiomas may manifest as difficult feeding and failure to thrive. Topical lidocaine-containing preparations, acetaminophen, and codeine have all been used for pain control. Smidt and Strand reported a painful hemangioma controlled with over-the-counter Orabase. Orabase contains 20% benzocaine, and possible adverse effects include allergic contact dermatitis and methemoglobinemia.^[63]

Class Summary

Steroids have become a mainstay in the treatment of proliferating hemangiomas in infants and children. These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

Prednisone (Meticorten, Orasone, Deltasone, Sterapred)

View full drug information

Prednisone is an immunosuppressant for the treatment of autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Prednisone stabilizes lysosomal membranes and suppresses lymphocyte and antibody production.

Class Summary

These agents are naturally produced proteins with antiviral, antitumor, and immunomodulatory actions. Alpha, beta, and gamma interferons may be given topically, systemically, and intralesionally.

Interferon alfa-2b (Intron-A)

View full drug information

Interferon alfa-2b is a protein product manufactured by recombinant DNA technology. Its mechanism of antitumor activity is not clearly understood; however, direct antiproliferative effects against malignant cells and modulation of host immune response may play important roles.

Propranolol

View full drug information

Propranolol hydrochloride is a synthetic nonselective beta-adrenergic receptor blocking agent. A generic form is available as 10-, 20-, 40-, 60-, and 80-mg tablets and as 60-, 80-, 120-, and 180-mg extended-release tablets. Inderal is available as 10-, 20-, 40-, 60-, and 80-mg tablets for oral administration. InnoPran XL is available as 80- and 120-mg extended-release tablets. No commercially available liquid formulation is available for use in children and must be formulated by a qualified pharmacist. It is indicated for hypertension and a variety of other cardiac conditions (angina) and migraine headache prophylaxis.

Benzocaine

View full drug information

Benzocaine is a PABA derivative ester-type local anesthetic that is minimally absorbed. It inhibits neuronal membrane depolarization, blocking nerve impulses. It is used to control pain.

Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 1982 Mar. 69(3):412-22. [QxMD MEDLINE Link].
Waner M, Suen JY, Dinehart S. Treatment of hemangiomas of the head and neck. Laryngoscope. 1992 Oct. 102(10):1123-32. [QxMD MEDLINE Link].
Sasaki GH, Pang CY, Wittliff JL. Pathogenesis and treatment of infant skin strawberry hemangiomas: clinical and in vitro studies of hormonal effects. Plast Reconstr Surg. 1984 Mar. 73(3):359-70. [QxMD MEDLINE Link].
Folkman J, Klagsbrun M. Angiogenic factors. Science. 1987 Jan 23. 235(4787):442-7. [QxMD MEDLINE Link].
Takahashi K, Mulliken JB, Kozakewich HP, Rogers RA, Folkman J, Ezekowitz RA. Cellular markers that distinguish the phases of hemangioma during infancy and childhood. J Clin Invest. 1994 Jun. 93(6):2357-64. [QxMD MEDLINE Link]. [Full Text].
Christison-Lagay ER, Fishman SJ. Vascular anomalies. Surg Clin North Am. 2006 Apr. 86(2):393-425, x. [QxMD MEDLINE Link].
Stal S, Hamilton S, Spira M. Hemangiomas, lymphangiomas, and vascular malformations of the head and neck. Otolaryngol Clin North Am. 1986 Nov. 19(4):769-96. [QxMD MEDLINE Link].
Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics. 1976 Aug. 58(2):218-22. [QxMD MEDLINE Link].
Amir J, Metzker A, Krikler R, Reisner SH. Strawberry hemangioma in preterm infants. Pediatr Dermatol. 1986 Sep. 3(4):331-2. [QxMD MEDLINE Link].
de Lorimier AA. Sclerotherapy for venous malformations. J Pediatr Surg. 1995 Feb. 30(2):188-93; discussion 194. [QxMD MEDLINE Link].
Dahlin DC, Unni KK. Bone Tumors: General Aspects and Data on 8,542 Cases. Springfield, Ill: Thomas. 1986.
Hayward JR. Central cavernous hemangioma of the mandible: report of four cases. J Oral Surg. 1981 Jul. 39(7):526-32. [QxMD MEDLINE Link].
Cuesta Gil M, Navarro-Vila C. Intraosseous hemangioma of the zygomatic bone. A case report. Int J Oral Maxillofac Surg. 1992 Oct. 21(5):287-91. [QxMD MEDLINE Link].
Wolf GT, Daniel F, Krause CJ, Kaufman RS. Intramuscular hemangioma of the head and neck. Laryngoscope. 1985 Feb. 95(2):210-3. [QxMD MEDLINE Link].
Marchuk DA. Pathogenesis of hemangioma. J Clin Invest. 2001 Mar. 107(6):665-6. [QxMD MEDLINE Link].
Barrett AW, Speight PM. Superficial arteriovenous hemangioma of the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Dec. 90(6):731-8. [QxMD MEDLINE Link].
Yih WY, Ma GS, Merrill RG, Sperry DW. Central hemangioma of the jaws. J Oral Maxillofac Surg. 1989 Nov. 47(11):1154-60. [QxMD MEDLINE Link].
Bowers RE, Graham EA, Tomlinson KM. The natural history of the strawberry nevus. Arch Dermatol. 1960. 82:667-680.
Lister WA. The natural history of strawberry nevi. Lancet. 1938. 1:1429-1434.
Bivings L. Spontaneous regression of angiomas in children; twenty-two years' observation covering 236 cases. J Pediatr. 1954 Dec. 45(6):643-7. [QxMD MEDLINE Link].
Blackfield HM, Morris WJ, Torrey FA. Visible hemangiomas: a preliminary statistical report of a 10-year study. Plast Reconstr Surg. 1960. 26:326-329.
Grabb WC, Dingman RO, Oneal RM, Dempsey PD. Facial hamartomas in children: neurofibroma, lymphangioma, and hemangioma. Plast Reconstr Surg. 1980 Oct. 66(4):509-27. [QxMD MEDLINE Link].
Yonetsu K, Nakayama E, Kawazu T, Kanda S, Ozeki S, Shinohara M. Value of contrast-enhanced magnetic resonance imaging in differentiation of hemangiomas from lymphangiomas in the oral and maxillofacial region. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Oct. 88(4):496-500. [QxMD MEDLINE Link].
Johann AC, Salla JT, Gomez RS, de Aguiar MC, Gontijo B, Mesquita RA. GLUT-1 in oral benign vascular lesions. Oral Dis. 2007 Jan. 13(1):51-5. [QxMD MEDLINE Link].
Kane WJ, Morris S, Jackson IT, et al. Significant hemangiomas and vascular malformations of the head and neck: clinical management and treatment outcomes. Ann Plast Surg. 1995 Aug. 35(2):133-43. [QxMD MEDLINE Link].
Mulliken JB, Boon LM, Takahashi K, et al. Pharmacologic therapy for endangering hemangiomas. Curr Opin Dermatol. 1995. 109-113.
Leaute-Labreze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taieb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 06/08. 358(24):2649-51.
Siegfried EC, Keenan WJ, Al-Jureidini S. More on propranolol for hemangiomas of infancy. N Engl J Med. 12/08. 359(26):2846-7.
Antaya RJ. Infantile Hemangioma. Medscape Reference. June 2010. [Full Text].
Herrero Hernández A, Escobosa Sánchez O, Acha García T. Successful treatment with vincristine in PHACES syndrome. Clin Transl Oncol. April 2007. 9(4):262-3. [QxMD MEDLINE Link].
Fost NC, Esterly NB. Successful treatment of juvenile hemangiomas with prednisone. J Pediatr. 1968 Mar. 72(3):351-7. [QxMD MEDLINE Link].
Edgerton MT. The treatment of hemangiomas: with special reference to the role of steroid therapy. Ann Surg. 1976 May. 183(5):517-32. [QxMD MEDLINE Link].
Pope E, Krafchik BR, Macarthur C, Stempak D, Stephens D, Weinstein M, et al. Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial. Pediatrics (Epub). May 2007. 119(6):e1239-47. [QxMD MEDLINE Link].
Bartoshesky LE, Bull M, Feingold M. Corticosteroid treatment of cutaneous hemangiomas: how effective? A report on 24 children. Clin Pediatr (Phila). 1978 Aug. 17(8):625, 629-38. [QxMD MEDLINE Link].
Hawkins DB, Crockett DM, Kahlstrom EJ, MacLaughlin EF. Corticosteroid management of airway hemangiomas: long-term follow-up. Laryngoscope. 1984 May. 94(5 Pt 1):633-7. [QxMD MEDLINE Link].
Hasan Q, Tan ST, Gush J, Peters SG, Davis PF. Steroid therapy of a proliferating hemangioma: histochemical and molecular changes. Pediatrics. 2000 Jan. 105(1 Pt 1):117-20. [QxMD MEDLINE Link].
Blei F, Isakoff M, Deb G. The response of parotid hemangiomas to the use of systemic interferon alfa-2a or corticosteroids. Arch Otolaryngol Head Neck Surg. 1997 Aug. 123(8):841-4. [QxMD MEDLINE Link].
Greinwald JH, Burke DK, Bonthius DJ, Bauman NM, Smith RJ. An update on the treatment of hemangiomas in children with interferon alfa-2a. Arch Otolaryngol Head Neck Surg. 1999 Jan. 125(1):21-7. [QxMD MEDLINE Link].
Barlow CF, Priebe CJ, Mulliken JB, Barnes PD, Mac Donald D, Folkman J. Spastic diplegia as a complication of interferon Alfa-2a treatment of hemangiomas of infancy. J Pediatr. 1998 Mar. 132(3 Pt 1):527-30. [QxMD MEDLINE Link].
Bigorre M, Van Kien AK, Valette H. Beta-blocking agent for treatment of infantile hemangioma. Plast Reconstr Surg. 2009 Jun. 123(6):195e-6e. [QxMD MEDLINE Link].
Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015 Feb 19. 372 (8):735-46. [QxMD MEDLINE Link].
Sommers Smith SK, Smith DM. Beta blockade induces apoptosis in cultured capillary endothelial cells. In Vitro Cell Dev Biol Anim. 2002 May. 38(5):298-304. [QxMD MEDLINE Link].
Ran Y, Chen S, Dai Y, Kang D, Lama J, Ran X, et al. Successful treatment of oral itraconazole for infantile hemangiomas: a case series. J Dermatol. 2015 Feb. 42 (2):202-6. [QxMD MEDLINE Link].
Berenstein A, Lasjaunias P, Kricheff II. Functional anatomy of the facial vasculature in pathologic conditions and its therapeutic application. AJNR Am J Neuroradiol. 1983 Mar-Apr. 4(2):149-53. [QxMD MEDLINE Link].
Muto T, Kinehara M, Takahara M, Sato K. Therapeutic embolization of oral hemangiomas with absolute ethanol. J Oral Maxillofac Surg. 1990 Jan. 48(1):85-8. [QxMD MEDLINE Link].
Gilbert LD, Bakos LH, Graves RW. Sodium morrhuate--an alternative in the treatment of soft tissue hemangiomas. Review of the literature and case reports. W V Dent J. 1981 Apr. 55(2):11-5. [QxMD MEDLINE Link].
Chin DC. Treatment of maxillary hemangioma with a sclerosing agent. Oral Surg Oral Med Oral Pathol. 1983 Mar. 55(3):247-9. [QxMD MEDLINE Link].
O'Donovan JC, Donaldson JS, Morello FP, Pensler JM, Vogelzang RL, Bauer B. Symptomatic hemangiomas and venous malformations in infants, children, and young adults: treatment with percutaneous injection of sodium tetradecyl sulfate. AJR Am J Roentgenol. 1997 Sep. 169(3):723-9. [QxMD MEDLINE Link].
Baurmash H, Mandel L. The nonsurgical treatment of hemangioma with Sotradecol. Oral Surg Oral Med Oral Pathol. 1963 Jul. 16:777-82. [QxMD MEDLINE Link].
Minkow B, Laufer D, Gutman D. Treatment of oral hemangiomas with local sclerosing agents. Int J Oral Surg. 1979 Feb. 8(1):18-21. [QxMD MEDLINE Link].
Govrin-Yehudain J, Moscona AR, Calderon N, Hirshowitz B. Treatment of hemangiomas by sclerosing agents: an experimental and clinical study. Ann Plast Surg. 1987 Jun. 18(6):465-9. [QxMD MEDLINE Link].
Baurmash H, DeChiara S. A conservative approach to the management of orofacial vascular lesions in infants and children: report of cases. J Oral Maxillofac Surg. 1991 Nov. 49(11):1222-5. [QxMD MEDLINE Link].
Seccia A, Salgarello M. Treatment of angiomas with sclerosing injection of hydroxypolyethoxydodecan. Angiology. 1991 Jan. 42(1):23-9. [QxMD MEDLINE Link].
Glassberg E, Lask G, Rabinowitz LG, Tunnessen WW Jr. Capillary hemangiomas: case study of a novel laser treatment and a review of therapeutic options. J Dermatol Surg Oncol. 1989 Nov. 15(11):1214-23. [QxMD MEDLINE Link].
Apfelberg DB. Intralesional laser photocoagulation-steroids as an adjunct to surgery for massive hemangiomas and vascular malformations. Ann Plast Surg. 1995 Aug. 35(2):144-8; discussion 149. [QxMD MEDLINE Link].
Suen JY, Waner M. Treatment of oral cavity vascular malformations using the neodymium:YAG laser. Arch Otolaryngol Head Neck Surg. 1989 Nov. 115(11):1329-33. [QxMD MEDLINE Link].
Dixon JA, Davis RK, Gilbertson JJ. Laser photocoagulation of vascular malformations of the tongue. Laryngoscope. 1986 May. 96(5):537-41. [QxMD MEDLINE Link].
Goldwyn RM, Rosoff CB. Cryosurgery for large hemangiomas in adults. Plast Reconstr Surg. 1969 Jun. 43(6):605-11. [QxMD MEDLINE Link].
Murphy JB. The management of a large hemangioma of the oral cavity with cryotherapy. J Oral Med. 1978 Jul-Sep. 33(3):104-6. [QxMD MEDLINE Link].
Gongloff RK. Treatment of intraoral hemangiomas with nitrous oxide cryosurgery. Oral Surg Oral Med Oral Pathol. 1983 Jul. 56(1):20-4. [QxMD MEDLINE Link].
Hartmann PK, Verne D, Davis RG. Cryosurgical removal of a large oral hemangioma. Oral Surg Oral Med Oral Pathol. 1984 Sep. 58(3):280-2. [QxMD MEDLINE Link].
Greene LA, Freedman PD, Friedman JM, Wolf M. Capillary hemangioma of the maxilla. A report of two cases in which angiography and embolization were used. Oral Surg Oral Med Oral Pathol. 1990 Sep. 70(3):268-73. [QxMD MEDLINE Link].
Strand M, Smidt AC. Pain management for ulcerated infantile hemangiomas. Pediatr Dermatol. 2012 Jan-Feb. 29(1):124-6. [QxMD MEDLINE Link].

Media Gallery

of 0

Table 1. Classification of Vasoformative Tumors

Vasoformative Tumor	New Nomenclature	Old Nomenclature
Hemangiomas
	Capillary hemangioma	Strawberry hemangioma
		Juvenile hemangioma
	Cavernous hemangioma
	Mixed hemangioma	Parotid hemangioma
Vascular malformations
	Venous malformation	Cavernous hemangioma
		Hemangiomatosis
	Intramuscular venous malformation	Intramuscular hemangioma
	Capillary malformation	Capillary hemangioma
		Port-wine stain
	Arteriovenous malformation	Arteriovenous hemangioma Arterial angioma Arteriovenous aneurysm Cirsoid angioma Red angioma Serpentine aneurysm
	Lymphatic malformation	Capillary lymphangioma Cavernous lymphangioma Lymphangioma Cystic hygroma

Table 2. Complications From Ablative Surgery Following Embolotherapy or Sclerotherapy for Hemangiomas and Vascular Malformations

Complications	Hemangiomas, %	Vascular Malformations, %
Immediate Complications
Hemorrhage	27	60
Airway compromise	2	10
Hematoma	14	14-30
Skin necrosis	12	10-30
Coagulopathy	7	14-20
Late Complications
Restricted oral opening	8	27-40
Malocclusion	8	20-40
Drooling	23	40-47
Dysphagia	23	20-27

Back to List

Author

Steven Brett Sloan, MD Professor, Department of Dermatology, University of Connecticut School of Medicine; Residency Program Director, Connecticut Veterans Affairs Healthcare System

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Academy of Dermatology<br/>Received income in an amount equal to or greater than $250 from: American Academy of Dermatology.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, American Dental Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Neil Shear, MD Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada

Neil Shear, MD is a member of the following medical societies: Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Dermatology Association, American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

Acknowledgements

Randall Wilk, MD, DDS, PhD Associate Professor, Department of Oral and Maxillofacial Surgery, Louisiana State University Health Science Center

Randall Wilk, MD, DDS, PhD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association, and American Medical Association

Disclosure: Nothing to disclose.

Oral Hemangiomas Medication

Medication Summary

Corticosteroids

Class Summary

Prednisone (Meticorten, Orasone, Deltasone, Sterapred)

Prednisone (Meticorten, Orasone, Deltasone, Sterapred)

Interferons