Your browser doesn't support javascript.
loading
Clinical Features, Prognostic Factors, and Treatment Interventions for Ulceration in Patients With Infantile Hemangioma.
Fernández Faith, Esteban; Shah, Sonal; Witman, Patricia M; Harfmann, Katya; Bradley, Flora; Blei, Francine; Pope, Elena; Alsumait, Anwar; Gupta, Deepti; Covelli, Isabela; Streicher, Jenna L; Cotton, Colleen; Tollefson, Megha; Nguyen, Henry; Hunt, Raegan; Moore-Clingenpeel, Melissa; Frieden, Ilona J.
Afiliación
  • Fernández Faith E; Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus.
  • Shah S; Department of Dermatology, School of Medicine, University of California, San Francisco.
  • Witman PM; Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
  • Harfmann K; Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus.
  • Bradley F; Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus.
  • Blei F; Department of Dermatology, School of Medicine, University of California, San Francisco.
  • Pope E; Department of Pediatrics, Lenox Hill Hospital, Northwell Health, New York, New York.
  • Alsumait A; Section of Pediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
  • Gupta D; Section of Pediatric Dermatology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
  • Covelli I; Department of Dermatology, University of Washington School of Medicine, Seattle.
  • Streicher JL; Department of Dermatology, University of Washington School of Medicine, Seattle.
  • Cotton C; Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
  • Tollefson M; Department of Dermatology, Indiana University School of Medicine, Indianapolis.
  • Nguyen H; Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
  • Hunt R; Division of Pediatric Dermatology, Medical University of South Carolina, Charleston.
  • Moore-Clingenpeel M; Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota.
  • Frieden IJ; Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota.
JAMA Dermatol ; 157(5): 566-572, 2021 05 01.
Article en En | MEDLINE | ID: mdl-33787840
Importance: Ulceration is a common complication of infantile hemangioma (IH), which leads to substantial morbidity. Ulceration in IH has not been systematically studied since the advent of ß-blocker therapy for IH. Objectives: To examine treatment interventions used for ulceration in IH and identify clinical prognostic indicators of healing time. Design, Setting, and Participants: A retrospective, multicenter cohort study was conducted on 436 consecutive patients with a clinical diagnosis of ulcerated IH and available clinical photographs. Patients receiving care at tertiary referral centers evaluated between 2012 and 2016 were included; statistical and data analysis were performed from February 7 to April 27, 2020. Exposures: Clinical characteristics, treatment interventions, course, complications, and resource use were analyzed. Treatment interventions for ulceration in IH included local (wound care, topical), systemic (ß-blocker, corticosteroids), and procedural (pulsed-dye laser). Main Outcomes and Measures: The primary end point was time to complete or nearly complete ulceration healing. Clinical characteristics were analyzed to determine the responses to most common interventions and prognostic factors for healing of ulceration. Results: Of the 436 patients included in the study, 327 were girls (75.0%); median age at ulceration was 13.7 weeks (interquartile range, 8.86-21.30 weeks). The median heal time was 4.79 weeks (95% CI, 3.71-5.86 weeks) with wound care alone, 5.14 weeks (95% CI, 4.57-6.00 weeks) with timolol, 6.36 weeks (95% CI, 5.57-8.00 weeks) with a systemic ß-blocker, and 7.71 weeks (95% CI, 6.71-10.14 weeks) with multimodal therapy. After adjusting for IH size, a dose of propranolol less than or equal to 1 mg/kg/d was associated with shorter healing time compared with higher propranolol doses (hazard ratio, 2.04; 95% CI, 1.11 to 3.73; P = .02). Size of the IH was identified as a significant prognostic factor for healing time in multivariable analysis. Increasing size of IH portends a proportionately longer time to heal of the ulceration. Conclusions and Relevance: Despite the use of ß-blockers, this cohort study found that a subset of patients with IH ulceration continued to experience prolonged IH healing times. Larger IH size appears to be a poor prognostic factor for time to heal. For patients requiring systemic therapy, initiation of propranolol at lower doses (≤1 mg/kg/d) should be considered.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Cutáneas / Úlcera Cutánea / Hemangioma Capilar Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Infant / Male Idioma: En Revista: JAMA Dermatol Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Cutáneas / Úlcera Cutánea / Hemangioma Capilar Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Infant / Male Idioma: En Revista: JAMA Dermatol Año: 2021 Tipo del documento: Article Pais de publicación: Estados Unidos