During the past several years, there have been new advancements in the management of
infantile hemangiomas (IHs). In many patients, no treatment is ever necessary—because
IHs are well known for their natural history of spontaneous involution. However, a significant
minority of hemangiomas do require treatment. Moreover, they are very heterogeneous,
making the decision of when, how, and why to intervene quite variable. The least
common but most important rationale for intervention is the presence of a life- or functionthreatening
complication, where prompt therapeutic intervention is a necessity. A much
more common scenario is ulceration, where appropriate management is needed to expedite
healing and control pain. Increasingly, the life-altering aspects of hemangioma are being
recognized as a rationale for treatment because permanent scarring and disfigurement can
result even if involution is complete. Treatments for IHs currently include topical, intralesional,
and systemic therapies. Laser and surgical modalities are also sometimes used
depending on the clinical scenario. In the absence of rigorous evidence-based studies,
clinicians must carefully weigh the risks and benefits of medical or surgical treatments
versus observation alone in tailoring management to the specific clinical situation at hand.
Semin Cutan Med Surg 29:106-114 © 2010 Elsevier Inc. All rights reserved.

During the past several years, there have been new advancements in the management of
infantile hemangiomas (IHs). In many patients, no treatment is ever necessary—because
IHs are well known for their natural history of spontaneous involution. However, a significant
minority of hemangiomas do require treatment. Moreover, they are very heterogeneous,
making the decision of when, how, and why to intervene quite variable. The least
common but most important rationale for intervention is the presence of a life- or functionthreatening
complication, where prompt therapeutic intervention is a necessity. A much
more common scenario is ulceration, where appropriate management is needed to expedite
healing and control pain. Increasingly, the life-altering aspects of hemangioma are being
recognized as a rationale for treatment because permanent scarring and disfigurement can
result even if involution is complete. Treatments for IHs currently include topical, intralesional,
and systemic therapies. Laser and surgical modalities are also sometimes used
depending on the clinical scenario. In the absence of rigorous evidence-based studies,
clinicians must carefully weigh the risks and benefits of medical or surgical treatments
versus observation alone in tailoring management to the specific clinical situation at hand.
Semin Cutan Med Surg 29:106-114 © 2010 Elsevier Inc. All rights reserved.