Skin hemangioma in children treatment. Modern classification schemes for neoplasms. Sclerotherapy of hemangiomas in children

Main symptoms:

• The neoplasm turns pale when pressed
• Tumor-like formation on the skin of a blue-purple color
• Increased temperature in the affected area

Hemangioma in children is a vascular neoplasm, which is predominantly non-malignant in nature and is located on the skin and mucous membranes. Sometimes this tumor can occur inside organs and in this case it can be difficult to diagnose, because until a certain time the tumor has no manifestations. Hemangioma often occurs in newborns - its manifestations can be seen either immediately after birth, or after several weeks or months. However, this tumor can appear in more late age, as well as in adolescence (against the background hormonal changes organism).

The tumor develops more often in girls than in boys. It is localized mainly on the face (including the lip, forehead, etc.), scalp and back. The locations of hemangioma in a newborn are also:

• limbs;
• crotch;
• genitals.

Note that if a hemangioma occurs in a newborn immediately after birth, then they speak of congenital pathology. If the tumor develops over the next months or even years of life, it is acquired. Although children have a congenital predisposition to pathology in both cases.

Causes

The reasons for the development of hemangioma in children are not fully understood. The pathology is congenital in nature, as it begins to develop in the fetus in the womb. It can appear either immediately after birth or after a few months. A tumor occurs in the fetus even during its formation. vascular system, what happens in the first trimester, and if during this period any unfavorable factors affected the mother and the child in her womb, then a vascular tumor may appear.

At the same time, there are factors that can provoke the appearance of such a pathology in an infant. These factors include:

• viral diseases of women in the early stages of pregnancy;
• taking by a woman while carrying a baby some medicines;
• mother's age over 40 years;
• multiple pregnancy;
• spicy endocrine diseases, which appeared or worsened when a woman was carrying a baby.

Unfavorable ecology in the region where a pregnant woman lives can also provoke the appearance of hemangioma in a newborn baby. In addition, hemangiomas in children are on the head, lip, eyelids or even internal organs appear when a woman’s pregnancy proceeds with complications, for example, in cases where she develops or is detected.

In adolescents, the reasons for the development of such a vascular tumor lie not only in hormonal changes - hemangioma on the face, head or body can also appear due to liver disease, which is confirmed by research.

Symptoms

It is not at all difficult to understand that a hemangioma has appeared in a newborn, because this vascular neoplasm has characteristic features. In particular, it has clearly defined edges, a bright brown, red or gray-red color, and a tendency to grow.

Hemangioma in children is most often located in the following areas of the body:

• on the lip, in the mouth, on the genitals;
• on the legs and arms, back and stomach;
• on internal organs;
• on the face;
• on the head (in the back of the head, behind the ears, on the scalp);
• inside the bones.

Symptoms of neonatal hemangioma depend on the location of the neoplasm. Usually the tumor is visible to the naked eye and the only symptom is a visual defect. If the child’s hemangioma is located near important organs and grows quickly, there may be dysfunction of those organs, for example, decreased vision, etc.

The location of the tumor on the internal organs is not determined for many years, so parents of children are not aware of this problem. Such a hemangioma in an infant or an older child can be detected accidentally during an ultrasound examination and examinations to identify various diseases. Symptoms appear as the formation grows - pain is possible due to pressure on neighboring organs or compression of nerve endings.

The appearance of newborn hemangioma is typical - it is a flat or nodular neoplasm that is located on the nose, lip, head and other areas. Protrudes above the surface of the skin or goes flush with it, has a smooth surface.

Most often, hemangiomas of newborns have a bright brown color - when pressure is applied to the neoplasm, it turns pale and then regains its original color. At the same time, the location of the tumor not on the surface, but in the thickness of the tissue, can cause the color of the tumor to be barely different from the color of the skin or acquire a bluish tint. In this case, a hemangioma located on the skin of a newborn or an older child will differ in temperature - the temperature in the area with the tumor will be higher than the temperature of the rest (healthy) skin.

It must be said that hemangioma in newborns and older children can disappear spontaneously - in 70% of cases, by the age of 5-6 years, such neoplasms lighten and completely disappear. If tumor regression occurs before 4 years of age, no scar remains on the skin, but if it regresses when a child is 7 years of age or older, a scar may form at the site of the former tumor.

Classification

A hemangioma that forms in a newborn or older child may have different localization, and not in terms of location on the face, lip or back, but in terms of being on the surface or in the inner layers of the skin.

Depending on this, there are 4 types of vascular neoplasms:

• simple or capillary;
• cavernous;
• combined;
• mixed.

Simple hemangiomas of adolescents and newborns consist of capillaries skin. Such a neoplasm can have slow, medium or fast growth. If the tumor grows, surgical treatment is required, which consists of removing the tumor with one of the existing medical practice ways.

Cavernous hemangioma in newborns is a formation consisting of several vascular cavities combined into a single whole. Such tumors are covered with skin, so their color is paler than capillary tumors.

When they talk about combined hemangiomas in infants and newborns, they mean a combination of the two forms described above. The mixed form means that the neoplasm includes not only vascular tissues, but also others - usually such hemangioma in newborns and children occurs when the tumor is located on the internal organs.

Diagnosis and treatment

Hemangioma in newborns is diagnosed based on visual examination. The doctor examines and feels the baby, but older children are subjected to ultrasound examination. Ultrasound is also prescribed in cases where the presence of a tumor is suspected on internal organs or inside the spine (in order to clarify the location of the tumor). Sometimes hemangiomas are detected in newborns and older children during MRI or CT, as well as during dermatoscopy and angiography.

Before prescribing treatment for hemangioma in an infant or older child, the doctor must determine the phase of development and carefully observe the tendency for the tumor to increase or decrease. If rapid growth is observed, removal of the tumor is indicated; if the tumor does not grow or grows very slowly, observation of the child is indicated.

Today, the most gentle method, which is suitable in most cases, is laser removal of hemangioma in children, since this procedure is painless and allows you to get rid of the tumor without leaving scars on the child’s face, head and body. Of course, such removal cannot be used in cases where hemangioma of internal organs is diagnosed in newborns - in this case they resort to drug treatment or open surgical intervention(when the tumor threatens the health or causes pain to children).

Another surgical treatment for a pathology such as hemangioma in newborns and older children is:

• cryodestruction;
• sclerosis;
• diathermocoagulation (electrical shock treatment);
• surgical removal.

Indications for removal of a tumor on the lip, head, face and genitals may be infection or self-ulceration of the tumor. Also, in some cases, drug treatment is indicated for neonatal hemangioma. For this purpose, hormonal drugs are used, which are selected by the doctor, or a medicine such as Propranolol. Treatment with antibiotics for this pathology is not effective, but you can try to treat the tumor traditional methods, for example, kombucha, mumiyo solution, etc. True, the effectiveness of such methods has not been proven, although there is an effect for small hemangiomas of newborns, which tend to regress.

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Hemangioma is a benign tumor consisting of small blood vessels. Hemangioma appears in a child immediately at birth or in the first month of life. Fast growth formation is noted only in the first half of the year; later it stops increasing, and sometimes can completely self-destruct.

Although hemangioma is benign neoplasm, like any disease, it can have complications. Therefore, as soon as you discover a tumor on your child’s body, consult a doctor immediately.

Causes of hemangiomas

Hemangioma is congenital disease and is formed in utero. The exact cause of the development of hemangiomas has not been identified, but there is a theory about the mechanism of formation of this formation.

When exposed to the fetus unfavorable factors, cells lining inner wall vessels (endothelium), can get into any part of the child’s body - onto the skin, into the internal organs. A vascular tumor will form at the site of their formation.

Factors contributing to the development of hemangioma include:

• spicy respiratory diseases suffered by a pregnant woman in the 1st trimester;
• high blood pressure in a pregnant woman (eclampsia), causing oxygen starvation baby;
• hypoxia of the fetal brain;
• intoxication effects on the fetus (taking medications, alcohol, smoking);
• the occurrence of Rh conflict in the mother and fetus;
• the age of the woman in labor is over 35 years;
• prematurity of the newborn;
• hormonal disorders during pregnancy;
• influence of harmful environmental factors;
• family history of hemangiomas development.

Classification of hemangiomas

There are several classifications that divide a large variety of hemangiomas into groups. Further treatment tactics and possible complications depend on the type of hemangioma.

Depending on the location, hemangiomas are divided into three main groups:

1. Cutaneous hemangiomas. The formation is localized in the superficial layers of the skin.
2. Hemangiomas of parenchymal organs (brain, liver, pancreas, spleen, kidneys and others).
3. Hemangiomas of the musculoskeletal system (muscles, joints and spine).

Morphological classification takes into account the structure of the hemangioma:

1. Capillary (simple) hemangioma. Formed by capillaries, most often located on the surface of the skin. It is considered the most common and in a safe way hemangiomas. Externally, it is a red spot on the surface of the skin; over time, the hemangioma most often becomes darker. During the growth period, capillary hemangioma can protrude above the skin and have a bumpy surface.
2. Cavernous hemangioma is a vascular tumor consisting of dilated capillaries, densely anastomosing (connecting) with each other. There are cavernous hemangiomas of various sizes, single or multiple. There are also limited and diffuse hemangiomas. Cavernous hemangiomas can be located on the surface of the skin, in the thickness of the subcutaneous tissue, as well as on internal organs with increased blood supply (kidneys, liver, brain).
3. Combined hemangioma simultaneously consists of capillary and cavernous parts, so it can simultaneously occupy both the surface of the skin and subcutaneous tissue. Appearance and clinical course depends on the predominance of the capillary or cavernous component in the tumor.
4. Mixed hemangioma combines elements of a vascular tumor with other types of tissue (connective, nervous, lymphoid). These include angioneuromas, angiofibromas and others. Appearance of the tumor and clinical manifestations different because they depend on the structure of the fabric and their relationship to each other. Many doctors prefer to consider this type of neoplasm as an independent pathology that has the features of a vascular tumor.

Clinical course

The clinical manifestations of hemangiomas are varied and depend on the morphology, size of the formation, depth of tumor spread in the tissue, as well as the localization of the tumor.

Hemangioma in a newborn

It can be localized on any part of the skin - on the head, torso, limbs, external genitalia. On the skin at the site of the hemangioma, swelling and a change in skin color to red are visible. With a predominance of arteries, the color of the formation is bright red, with more venous vessels hemangioma has dark color(cherry, burgundy).

With physical stress, there is an increased flow of blood to the formation, so when a child cries, the hemangioma becomes bright color and more swollen.

When pressure is applied to the colored area of ​​skin, it turns pale, and after the compression stops, the hemangioma quickly takes on its normal appearance. If the formation is located subcutaneously, the skin color may be normal.

To the touch, hemangioma has a dense or soft-elastic consistency. As a rule, dense formations are not characterized by an increase in size, but soft-elastic hemangiomas can grow rapidly.

Sometimes, as the hemangioma increases in size, pain or sensory disturbances may be felt; this occurs due to compression of the nerve fibers.

Liver hemangioma

Liver hemangioma in children is asymptomatic and is mainly discovered by chance during an abdominal ultrasound. To determine the structure and location of the tumor, MRI of the liver is performed.

Kidney hemangioma

Kidney hemangioma - extremely rare disease. This formation is congenital, but is often diagnosed later. During active growth In the child, the formation also rapidly begins to grow, squeezing the surrounding tissues of the organ. The functioning of the kidney is impaired, resulting in clinical symptoms.

The following manifestations are characteristic of renal hemangioma:

• pain in the lumbar region, radiating to the groin;
• renal colic;
• uncontrolled increase blood pressure;
• the appearance of blood in the urine;
• increased body temperature;
• general lethargy and weakness of the child.

A small tumor may be asymptomatic. If a renal hemangioma is detected, it is indicated surgical treatment.

Spinal hemangioma

Spinal hemangioma is clinically manifested by constant intense pain in the back, which is not relieved by painkillers, massage and anti-inflammatory ointments.

Hemangioma can manifest itself clinically as an attack of osteochondrosis, and only upon examination is a neoplasm detected. In childhood, the disease is extremely rare. The diagnosis is confirmed by performing an MRI spinal column. Treatment tactics are selected individually.

Possible complications of hemangiomas

• One of the most common complications of skin hemangiomas is bleeding or ulceration of their surface. More often this occurs in formations subject to mechanical trauma;
• due to impaired blood supply, the development of trophic disorders of the skin around hemangiomas is possible;
• With special attention refer to hemangiomas localized on the face and scalp, as they are very close to important organs. Formations in the area of ​​the eyeballs and ears can put pressure on organs, disrupting their functions. A hemangioma located in the neck can compress the trachea and cause breathing problems;
• hemangiomas of internal organs can be complicated by abundant internal bleeding, up to hemorrhagic shock with fatal outcome.

Treatment of hemangioma in children

Treatment of hemangiomas in children is challenging. Modern medicine There are a wide variety of treatment methods known to eliminate hemangioma. The choice of treatment method depends on the size, location, structure, growth rate of the formation, as well as the child’s health condition.

Some methods are outdated and not used due to their danger (for example, x-ray therapy), and some are just beginning to be widely used in practice. Let's look at the most common methods of treating hemangiomas in modern medicine.

Surgery

Surgical treatment is a radical method of treatment that involves removing pathological formation within healthy tissues. Surgical treatment is quick and in an accessible way complete one-step removal of hemangiomas in children, but it has its drawbacks.

The operation is performed on children only under general anesthesia in a hospital setting. The most serious complication during surgical removal of hemangiomas is the difficult to stop profuse bleeding. In addition, inflammation is possible postoperative wound, as well as tumor relapses. After surgery, a scar is formed, which leads to an unsatisfactory cosmetic effect.

Thus, surgical treatment is more often used for mature hemangiomas that have stopped their growth and differentiation, localized mainly in parts of the body where cosmetics are not of great importance.

Electrocoagulation

Electrocoagulation is the use of high frequency electric current using special devices. At the point of tissue contact with the active electrode, coagulation occurs, destroying the tissue. This method it is very simple and effective, but is used only for small hemangiomas (up to 0.5 cm in diameter), since a scar remains at the site of the current.

Removal of hemangiomas with laser

Using special equipment, a laser sensor with a certain wavelength is used to impact the surface of the hemangioma. As a result of the action high temperatures pathological vascular formations collapse and are subsequently replaced by new healthy tissue.

Thanks to certain parameters of laser radiation, percutaneous coagulation of tumor vessels is carried out without damaging surrounding tissues, which leads to a good cosmetic effect. This method can remove hemangiomas on any part of the body, even on the eyelids. The procedure has no age restrictions.

Laser removal of formation does not require general anesthesia, it is enough to apply an anesthetic ointment to the site of the hemangioma in advance. Laser therapy is effective only when large sizes formations (up to 0.5 cm), and requires repeated exposure until the tumor is completely eliminated.

Cryotherapy

Cryotherapy is the use of cold effects on education. Liquid nitrogen is used as a cryoagent. Cryosurgery allows you to completely destroy a vascular tumor without damaging surrounding tissue.

Cryotherapy is an effective treatment for rapidly growing capillary hemangiomas, but not all hemangiomas are amenable to cold treatment.

Sclerosing therapy

This is the treatment chemicals, causing aseptic inflammation in the hemangioma and thrombosis of blood vessels, as a result of which the hemangioma “empties” and is replaced by connective tissue. Sclerosants are injected into the area of ​​the hemangioma.

For large hemangiomas it is dangerous to inject a large number of sclerosing agent, this can lead to ulceration of the skin with scar formation.

Earlier wide application had a solution of 70% alcohol. Currently, there are modern chemical sclerosing drugs. Sclerosing treatment of hemangiomas is used for small vascular tumors of complex anatomical localization (in the nose, eyelids, auricle, in the oral cavity).

A single injection of sclerosant is not enough; sometimes a long, multiple course of injections is required. Also, the disadvantage of the method is the pain of administering the substance.

Hormone therapy

There are several options hormonal treatment hemangiomas. The most commonly used corticosteroid therapy is prednisolone. When prednisolone is used, increased collagen formation occurs in the intervascular connective tissue and in the vessel wall. Connective tissue compresses the vessels, disrupting their patency, the capillaries undergo atrophy and become empty.

At hormonal effects there is a slowdown or complete cessation of growth of education. Hemangiomas respond especially well to hormone therapy in the first year of life. Hormone therapy is most often used as an auxiliary treatment method.

Use of β-blockers

Recently, β-blocker therapy has become widespread for the treatment of large hemangiomas of the face and trunk, as well as hemangiomas of internal organs. Treatment with these drugs is carried out under the strict supervision of a pediatric surgeon, pediatrician and cardiologist. The pediatric surgeon calculates the dose of the drug depending on the age and body weight of the child, and several courses are administered until the tumor is completely cleared.

Treatment is carried out under the control of hemodynamic parameters (pulse, blood pressure), since β-blockers affect not only the vessels of the hemangioma. Treatment with this group of drugs can only be carried out medical institution. has permission for this type of activity.

Combined treatment

Combination treatment is a combination of two or more methods of treating hemangiomas simultaneously, or sequentially one after another. It is used in complex cases when it is impossible to achieve using one technique complete cure hemangiomas, or tumor recurrences.

Conclusion

If you find a spot or tumor-like formation on a child’s body, you must contact pediatric surgeon who will choose optimal method treatment in this case. Parents should be prepared for the fact that after removal of the hemangioma, scarring may remain, but this is not comparable to the harm that the tumor can cause.

Timely initiation of treatment and right choice This method allows not only to quickly cure the child, but also to prevent the development of possible complications.

A hemangioma that appears on the body or face causes its owner a lot of trouble. Starting from the fact that it is not aesthetically pleasing and attracts the attention of others, hemangioma on the face can also cause serious pathological conditions. Let's figure out what the danger is and what this disease represents in children and adults.

Hemangioma or what is a vascular neoplasm

Scientists have found that hemangioma is a proliferation of vascular tissue or, in other words, a vascular tumor. It can occur suddenly in an adult or be diagnosed in a newborn child. Depending on the location, degree of growth and tendency to remission, doctors select the most suitable treatment for every patient. Distinctive feature hemangiomas is the fact that it never degenerates into a low-quality tumor.

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Reasons for development

Experts cannot individually indicate the exact causes of development in the adult population. But they identify a number of factors that predispose to the occurrence of this vascular tumor:

1. Hormonal imbalances characteristic of pregnancy, puberty and menopause can also provoke the development of a vascular tumor.
2. The indirect effect of medications on the child’s body that a woman took during pregnancy.
3. Heredity – genetic predisposition often causes tumor growth to begin.
4. ARVI suffered by a woman in the early stages of pregnancy. It is at this moment that the vascular system is formed, and viral infection often leads to the formation of this pathology.
5. Low birth weight can also cause hemangioma.
6. Pathological changes in the vascular system.

The cause of the development of hemangioma on the face can be either one of the above factors or a combination of them.

Early signs of hemangioma development in children and adults

The first signs of the appearance of a vascular tumor differ in adults and children. Therefore, we will consider how the tumor develops in each group of patients separately.

The child has

It should be noted that many babies are already born with this pathology and such newborns, according to various sources, range from 5 to 12%. At the same time, girls are 7 times more likely to develop pathology than boys.

The first signs of hemangioma on the face in children include:

1. A small spot will form. This is the first stage of pathology development.
2. Gradually the neoplasm turns red. In this case, they speak of stage 2 of the disease.
3. Then the tumor increases in size. It acquires a bluish tint and the surface becomes lumpy. These are stages 3 and 4 respectively.

Timely medical examination and high-quality examination of the baby allows you to identify hemangioma at an early stage of development.

In adults

The first signs of the development of the disease in adults are not too different from its development in a child.

A small spot appears on the face, which may subsequently increase in size. For many years it can go unnoticed because it is located deep in the skin. Common sites of localization are the face, parotid region and neck.

How can a hemangioma on the face be dangerous?

For children, this tumor of the superficial layers of the skin rarely presents serious danger. In 80% of cases, the vascular tumor recurs by the age of 5-8 years. It is important to explain to the child that you should not rub the affected area, and then the likelihood of the hemangioma disappearing significantly increases.

Some of the unpleasant aspects associated with a child having a hemangioma include:

1. Infection of a neoplasm as a result of injury.
2. Hemangiomas in children grow quickly, and after disappearing they can leave noticeable scars on the skin.
3. Localized in the eye area, a tumor in a child can cause partial or total loss vision.

For adults, the tumor is less dangerous, since the patient understands the importance of preserving the tumor without injury or scratching. Timely contact with specialists helps to get rid of the pathology.

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What treatment is being taken?

Modern medicine offers several effective ways combating vascular neoplasms.

Treatment in children

Some of the most accessible and popular ways to rid a child of hemangioma include:

Cryodestruction is a fast and effective manipulation for small tumors. Children tolerate the procedure well. It is carried out within the walls of a medical institution and consists of local exposure to cold on the tumor.

Sclerosis– used for average or small size a tumor that is localized deep in the tissue. Using a needle, a sclerosing substance is injected into the hemangioma. It causes a reduction in the size of the pathology, and then its complete replacement with scar tissue.

Surgical removal– is performed only if other methods turn out to be ineffective or impossible to use for any reason. can be removed surgically if it threatens the patient's vision, hearing or breathing.

Treatment in adults

For adults, localized on the face, it is carried out using one of the following methods:

1. Cryodestruction.
2. Sclerosis.
3. Electrocoagulation or exposure to high frequency current. A crust forms at the site of exposure, which subsequently falls off on its own.
4. to influence deep-lying hemangiomas.
5. A combination of cryodestructive method and ultrasound.
6. Laser exposure or photothermolysis. The most effective lasers are yellow and green (based on copper bromide), the wavelength of which is 578 nm. They have a detrimental effect on the cells of the vascular system and do not cause damage to healthy tissues.
7. Surgical intervention if there is no effect from other treatment methods.
8. Medicinal influence. It is carried out using hormonal drugs under the supervision of an endocrinologist and therapist.

Treatment of neoplasms with traditional methods is not only ineffective, but often contributes to increased growth of hemangioma.

Recovery period

To reduce the likelihood of relapse, you must carefully follow all the specialist’s recommendations after treatment. If methods of physical impact on the tumor were used, then it is important not to remove the crusts yourself and not to subject the lesion to mechanical impact.

Taking medications, following a diet and daily routine will strengthen the body's defense reactions and shorten the rehabilitation period.

Forecast

At early diagnosis and with correctly prescribed treatment, patients can avoid an unfavorable prognosis for the course of the disease.

To the number serious consequences development of vascular tumors include:

1. Thrombocytopenia and the development of anemia as a result of bleeding.
2. A cosmetic defect that causes a lot of inconvenience to its owner.
3. Germination of hemangioma into surrounding tissues and organs. Loss of hearing, vision, or suffocation may result from patient refusal of treatment.

Experts note that only in 20% of all cases when a patient is diagnosed hemangioma on the face, it resolves on its own. About 50% of neoplasms are gradually replaced by scar tissue. You should not delay visiting a doctor, especially if the specialist insists on diagnosis and treatment.

Recently, more and more often, young parents have to deal with the concept of hemangiomas in children. So what is it - hemangioma? And what does this mean for hemangioma for our children?

Hemangioma- benign vascular formation, which is a consequence of impaired vascular development during the embryonic period.

Hemangiomas in children have the following features:

• most hemangiomas in children occur in the first two to three weeks of life and appear in the first year of a child’s life; cases of congenital hemangiomas have become common;

• these neoplasms of blood vessels can become rapidly progressive. Spontaneous disappearance of hemangioma in a child may also occur.

Depending on the location of the hemangioma, the following types are distinguished:

• flat hemangioma;

• tuberous-flattened hemangioma;

• tuberous nodular hemangioma;

• cavernous hemangioma.

There are also mixed forms of hemangiomas in children. The color intensity of hemangiomas in children varies - from pink to red, from cherry to dark burgundy. The color of the hemangioma depends on the depth of its spread and the size of the lumen of the affected vessels.

Can hemangiomas go away without treatment?

Many hemangiomas in children can undergo spontaneous regression.

With the spontaneous disappearance of hemangiomas, three phases predominate: until the end of the first year of life; from one to five years (early involution); until the end of puberty (late involution).

The appearance of areas of whitish skin in the center of the hemangioma indicates the beginning of the healing process.

Further, the lightening spreads from the center to the edges of the hemangioma. Whitish areas can also appear on the periphery, they can be located chaotically, but over time they expand and merge. This process can take years. In 30% of cases, the reverse development is not completed completely with a successful result and requires additional manipulations in the future. Spontaneous disappearance does not guarantee excellent cosmetic results. Recovery can take place in different ways:

• change in color of the hemangiomas to a lighter color (depigmentation);

• flattening of hemangioma;

• scarring of hemangioma.

The greatest chance of remission with a good cosmetic effect is found in flat hemangiomas. It should be borne in mind that if recovery was preceded by ulceration of the hemangioma, then scars may appear in their place.

Where are hemangiomas most often located in children?

The head region is in first place in terms of the incidence of hemangiomas. Basically, hemangiomas are located on the eyelids, the forehead area up to the scalp, near the root or tip of the nose, on the cheeks, including the area of ​​the cheeks from the inside of the mouth, on the mucous membrane of the eyes. The second place in the frequency of damage is the genital area. Contamination of these places with urine and feces, friction with diapers or clothing can lead to ulcers and bleeding of hemangiomas, as well as infections in these places.

Often hemangiomas are found on the upper body, on the arms and legs of the child. Hemangiomas can also be located in places invisible to the eye: internal organs, soft tissues and bones. There are also cases of multiple hemangiomas in different places.

Is it necessary to treat hemangiomas in children?

At least 10% of hemangiomas can lead to various kinds of complications during the child’s life. Complications that occur serve as an immediate signal for treatment of hemangioma. This can be not only ulcerations with infection, but also disturbances in the functioning of the organ, severe anemia due to bleeding, strong growth of hemangiomas with disruption of adjacent tissues.

For indications for the treatment of hemangiomas it is also psychological condition parents and child. It is known that the reverse development of hemangiomas can last for years, and if the hemangioma is located at open areas, then this can bring some discomfort to the patient. One cannot underestimate the problems, fears and anxieties that arise, possible solitude and isolation, and family conflicts. For example, with nevus flammeus there are no complications, but one can only assume how difficult it is for relatives and the patient himself (in German this translates as birthmark or shameful stain):

• very often mothers blame themselves for such diseases in children;

• often there is a fear of bleeding as a result of injuries and scratches that patients and their loved ones cannot stop;

• beginning with kindergarten problems may arise with other children, often playmates begin to tease or even exclude the sick child from games;

• Psychologically, children can react to all this with aggression, depression, fearfulness or decreased attention.

The statement that hemangiomas in children need to be treated from the earliest stage of diagnosis or occurrence is not certain. Until now, wait-and-see tactics prevail among doctors, based on the fact that the hemangioma may undergo reverse development. The need for treatment is recognized only in the presence of complications. As a result of this delay therapeutic treatment A lot of time is wasted in the early stages of the disease.

Recently, the development of laser therapy has significantly changed the previous approach to expectant treatment of hemangiomas. It ended up in the hands of doctors effective method early therapy on an outpatient basis.

Treatment of hemangiomas in children

Today, doctors adhere to the following approaches in the treatment of hemangioma in children:

Hemangioma on the face and in the labia and anus is considered a cosmetic emergency and requires treatment within three days.
Hemangiomas with a clear tendency to grow (doubling the area of ​​distribution in one week) should be treated immediately, and with a different increase - within a week.
Hemangiomas in the mouth and inside the cheeks are also considered Emergency and must be lasered before surgical removal becomes necessary.
Considering the simplicity of the laser method for removing hemangiomas, the list of complications of hemangiomas for which laser therapy is indicated can be significantly expanded.

Taking into account the recommendations of the expert group “Hemangiomas in childhood”, you can follow the following steps. If the hemangioma is located on the face or in the anogenital area, then, in accordance with the mentioned recommendations, it is considered an emergency and appropriate laser therapy begins immediately after the diagnosis is established. If the hemangioma is located on another part of the body, then it can be observed further and, if there is a pronounced tendency to grow, it can be subjected to laser removal. If, on the contrary, growth arrest is observed, it is recommended to wait and use laser therapy only if complications occur. If a spontaneously disappearing hemangioma leaves behind traces, these should also be subjected to laser treatment to achieve a good cosmetic result.

For any type of hemangioma, it is necessary to photographically document the initial condition and its manifestations so that in the future it is possible to monitor the spread of the hemangioma and the progress of treatment.

Previous treatment options for hemangiomas in children.

All methods of treating hemangiomas before they appear laser methods gave a very high percentage of complications in comparison with the possibility of spontaneous disappearance of the hemangioma.

Radiation therapy of hemangiomas in children.

Today, one of the outdated methods of treating hemangiomas. Complete elimination of hemangioma using appropriate doses of radiation is practically unattainable. Emerging side effects(growth disorders, skin disorders) do not justify this method.

Sclerotherapy of hemangiomas in children.

With the help of sclerosing agents that are injected into the vessels, it is possible to achieve flattening of the hemangioma. Side effects: hyperpigmentation, tissue necrosis and other damage.

Cryotherapy of hemangiomas in children.

Since cryotherapy acts only superficially, it is used when cutaneous forms hemangiomas. After repeated treatments, the skin turns pale, and, as a rule, rough atrophic scars form, which require additional cosmetic and absorbable procedures.

Cortisone (hormonal) therapy for hemangiomas in children.

Presumably, when long-term use cortisone blocks the receptors responsible for the growth of the body. After cortisone withdrawal, growth resumes. It is likely that not all hemangiomas are associated with these receptors, since in 30% of cases this treatment has no effect. In addition to internal cortisone administration, it is possible to use local ointments, however, multiple complications (from local to general) may occur. It makes sense to use similar treatment How additional remedy in life-threatening conditions.

Magnesium filling of hemangiomas in children.

Pieces of pure magnesium wire are repeatedly implanted into the hemangioma. This stops the growth of hemangioma. Only large hemangiomas can be treated with the filling method. Application early treatment impossible with this method.

Surgical treatment of hemangiomas in children.

Surgical removal of parts of the tissue where the hemangioma is located is used. Risk surgical treatment quite high due to severe bleeding during operations, which often end various complications. Because of this complete removal on the face, for example, is practically unattainable. Moreover, there may be disfiguring effects of surgery or damage to the facial nerves.

Laser removal of hemangiomas in children.

Today, laser therapy is a significant alternative to previously used methods. Its most important advantage is that laser can treat all forms of vascular pathologies and at any stage of disease. In addition, the treatment can be divided into separate stages, which can be coordinated with aesthetic requirements. Laser treatment is practically painless, however, if the patient wishes, local painkillers in the form of creams and ointments can be used. After laser therapy, you need to pause and wait 2 to 6 weeks for it to completely disappear. inflammatory reaction. Before each subsequent laser treatment session, a conclusion is made about the result achieved during the previous sessions. Sometimes a one-time laser treatment is enough to remove a hemangioma; in other cases, more sessions are required. If after laser exposure there are signs of remission of the hemangioma, you can take a wait-and-see attitude and refrain from manipulation. As with any method of therapy, there is also a failure rate, but it is much lower than with any other methods, sometimes scarring may occur or the hemangioma may not respond to the laser. This depends both on the correctness of the chosen laser, the qualifications of the doctor, and on individual characteristics skin, such as hemangioma.

Which are formed from vascular tissues, often appear in newborns and older children. As a rule, the cause of hemangioma is anomalies in the embryonic development of the vascular system.

Externally, the tumor looks bluish or purplish-red, slightly rising above the skin, or flat spot. Such tumors tend to bleed and actively increase in size.

According to statistics, hemangiosal formations are diagnosed in 1-3% of newborn babies and in every 10 children in the first 12 months of life, and girls are the owners of such formations two to three times more often than boys.

Although the tumor is not malignant, it is capable of growing deeper, damaging surrounding organs, which is fraught with dysfunctional consequences for the respiratory, visual and auditory system child.

Classification

All hemangiosal tumors are divided into 4 types:

• Capillary or simple hemangioma - it consists of a cluster of tiny capillary vessels and is localized mainly on skin surface. Detected in 95% of cases;

Photo of capillary hemangioma on the lower eyelid of a newborn

• Cavernous– localized subcutaneously and consists of many cavities filled with blood content;

The photo clearly shows what a cavernous hemangioma looks like on a child’s face

• Combined– such a tumor has the characteristics of a simple and cavernous hemangioma, simultaneously being localized in the subcutaneous layers and on the skin;

The photo clearly shows what combined hemangioma looks like in children

• Mixed hemangiosal tumor has a multi-tissue structure and consists of lymphatic, nervous, vascular and connective tissue.

In addition, a hemangioma can be present at birth - a congenital tumor, or it can form later - an infantile hemangioma.

Causes of hemangioma in children

Hemangiovascular formations appear in infants and children for many reasons:

• Late motherhood, when a woman gives birth at a fairly mature age;
• Pathologies during pregnancy;
• Carrying twins, triplets, etc.;
• The birth of a child before the due date;
• Aggressive or unfavorable environmental environment of the pregnant woman;
• Relapse or exacerbation of an endocrine pathology in a pregnant woman;
• If in the first 6 months of bearing the baby the mother suffered from a viral infection;
• Abuse of certain medications.

How can you understand that a child has a hemangioma?

Sometimes by external signs a hemangiosal tumor resembles a mole. Therefore, it is important to distinguish between such neoplasms. As reported above, hemangiosal tumors are detected immediately after birth or in the first six months of a baby’s life. Typically in children, hemangiosal tumors are located:

• On the scalp, mainly on the back of the head and neck;
• On the face, eye, eyelids, forehead, nose, lip and cheeks;
• On the limbs of the arms and legs, as well as on the butt, stomach and back;
• On the mucous tissues of the tongue, lips, genitals or anus;
• On bone and cranial tissues;
• On intraorganic surfaces, for example.

Photo of a flat (capillary) hemangioma on the nose of a newborn

Hemangiomas in children are characterized by two stages of development:

1. Proliferative– this is the growth stage, it can last up to six months, during which time the tumor practically grows to its final parameters.
2. Involutionary- This is a stage of reverse development, in half of the cases it comes to an end at the age of five. By the age of 9, 90% of children experience the end of the involutionary period. By the end of involution, the area where the hemangioma was previously located will not always be indistinguishable from healthy tissue. Sometimes small marks and scars remain in these areas.

Hemangiosal formations may rise slightly above the epithelial surface or be flush with it. The sizes of such tumors vary from 0.1 to 15 cm. When touched, they feel somewhat hotter than the surrounding surfaces.

Characteristics of education

Types of hemangiomas differ not only in structure, but also in external characteristics:

• A simple hemangioma looks like a flat, sometimes lumpy, clearly defined spot of a bluish-red hue; when you press on the capillary tumor, its color will turn pale, but will quickly return to its previous saturation after the pressure is removed;
• Cavernous varieties of hemangiomas are distinguished by their typical slightly bluish tint. With tension in the surrounding tissues or during strong crying, such a hemangioma will become brighter and a little larger, but then will again acquire its original shades and sizes;
• Combined formations combine the features of cavernous and simple hemangiomas;
• Mixed hemangiosal tumors appear depending on the predominance of a particular type of tissue.

Features of childhood tumors

Hemangioma in children may differ in progressive growth. If such a tumor is localized in the nose or eyelid, visual or respiratory functions may be impaired. In addition, such tumors are prone to ulceration, bleeding, and infection, which can lead to various complications such as lymphadenitis, etc.

Approximately about ⅔ clinical cases characterized by hemangiogenic regression. It may take several years for complete resorption. Most tumors resolve by 7 years of age.

The fact that the formation has begun to involute is indicated by pale areas in its middle, which over time move towards the outskirts.

With early regression after hemangioma, no traces remain, but if the tumor resolves to the younger school age, then a slight trace remains in its place. If the hemangioma is characterized by congenital origin, then it acquires chronic form and during its development it does not grow particularly much and does not tend to disappear. This picture is most typical for teenagers.

How dangerous is a neoplasm?

In fact, hemangiosal tumors do not pose a danger to the child, but they are destructive.

In the process of growing deep into the tissue, the tumor can reach vital organs and lead to disruption of their functioning.

Diagnostics

For diagnostics, modern laboratory and hardware methods are used, such as:

• Dermoscopic examination;
• Ultrasound diagnostics (ultrasound);
• Angiographic examination;
• If necessary, it is prescribed, X-ray examination, MRI.

Treatment methods

Depends on their development and the depth of germination deep into the tissues. If such a formation is superficial, does not grow, and does not threaten the child’s health, then observational tactics are chosen.

If the tumor clearly complicates the child’s life, being located on the eyelid, near the mouth or in respiratory tract, then it must be removed. An indication for removal is also the tendency of the formation to bleed, ulcerate, or become traumatized.

Operational

Surgical procedures today are the most effective option treatment. Indications for such treatment are:

1. The location of the tumor is in the head, anogenital zone, on the face;
2. With intraocular location or localization on the oral mucosa;
3. If complications occur;
4. With the progressive growth of the formation, regardless of its location.

If such factors are present, tumor removal is indicated, but it should not be removed for children with severe health conditions and newborn babies. In general, removal is carried out in several ways:

• Surgical removal is indicated for large-scale tumor placement;
• Laser therapy today is considered the most effective and relatively affordable method of treating hemangios tumors. The average price of such treatment is about one and a half to two thousand rubles;
• involves freezing the vascular hemangioma with liquid nitrogen. This method cannot be used on the face;
• Sclerotherapy involves injecting a special solution into the formation, which will provoke vascular blockage and deprive the tumor of nutrition;
• Cauterization involves removing the formation by electrical action (diathermocoagulation effect);
• Radiotherapy involves irradiating the hemangioma.

If possible, removed materials are sent for histology.

Postoperative period

When the hemangiosal formation is removed, the child may be prescribed antibiotic medications. The wound must be treated daily with antiseptic agents.

Medication

For complicated hemangiomas, use medicinal methods treatments involving hormonal therapy and use . Hormonal drugs accelerate the resorption tumor processes. But such treatment does not have high rates of effectiveness, but it does have many adverse consequences.

The use of blockers like Propranolol helps reduce pressure in the vessels of the tumor, causing its nutrition to deteriorate and the formation begins to die. This treatment is different high efficiency and the absence of re-formation of hemangiosal tumors.

Photos before and after treatment of vascular hemangioma in an infant using the drug timolol

Many experts recommend treating hemangioma with anti-glaucoma drops. The solution is dripped onto the tumor three times a day for a long time, but after two to three weeks of use, a clear blanching of the hemangioma is observed.

Folk remedies

Traditional healers suggest treating hemangioma with dandelion infusion, celandine, kombucha, green juice walnuts or mumiyo and other means.

Independent use of any folk remedies, especially when treating a child, is unacceptable. Therefore, any actions of this nature necessarily require medical consultation.

Forecast

Approximately every seventh child experiences progression of hemangiosal tumors, which subsequently begin to reverse their development, lasting for years. As a result, the tumor can resolve with excellent cosmetic results, although more often a slight depigmented area or a small scar remains.

Since childhood hemangiomas are often characterized by rapid growth with accompanying complications, surgical treatment is usually used. Modern features help your child choose the safest and most effective technique treatment that will provide maximum result and will rid the baby of hemangiomas forever.

Video by Dr. Komarovsky about hemangioma in newborns: