Guideline sources The following summarized guidelines for the evaluation and management of infantile hemangioma are prepared by our editorial team based on guidelines from the American Academy of Pediatrics (AAP 2019). 1 Guidelines 1. Classification and risk stratification Risk stratification: Classify an infantile hemangioma as high risk if there is evidence of or potential for one the following: life-threatening complications functional impairment or ulceration structural anomalies (such as in PHACE syndrome or LUMBAR syndrome) permanent disfigurement. B Refer the patient to a hemangioma specialist as soon possible, after identifying an infantile hemangioma as high risk. B https://web.pathway.md/diseases/recdyqhJbtWIxkHxN 1/3 6/24/23, 2:28 PM Infantile hemangioma Pathway 2. Diagnostic investigations Imaging: do not obtain imaging unless the diagnosis of infantile hemangioma is uncertain, there are 5 cutaneous infantile hemangiomas, or associated anatomic abnormalities are suspected. D Show 2 more 3. Medical management Oral beta-blockers: offer oral propranolol as first-line therapy for patients with infantile hemangiomas requiring systemic treatment. B Show 3 more Topical beta-blockers: consider topical timolol maleate as a therapy for thin and/or superficial infantile hemangiomas. C Oral corticosteroids: consider oral prednisolone or prednisone to treat patients with infantile hemangiomas if there are contraindications or an inadequate response to oral propranolol. C 4. Therapeutic procedures Intralesional corticosteroid injections: consider intralesional injection of triamcinolone and/or betamethasone to treat patients with focal, bulky infantile hemangiomas during proliferation or in certain critical anatomic locations (for example, the lip). C 5. Surgical interventions Surgery: consider surgery as a treatment option in managing selected patients with infantile hemangiomas. C Laser therapy: consider laser therapy as a treatment option in managing selected patients with infantile hemangiomas. C 6. Patient education Parent education: educate caregivers of infant patients with an infantile hemangioma about the condition, including the expected natural history and its potential for causing complications or disfigurement. B References 1. Krowchuk DP, Frieden IJ, Mancini AJ et al. Clinical Practice Guideline for the Management of Infantile Hemangiomas. Pediatrics. 2019 Jan;143 1 . pii: e20183475. Open https://web.pathway.md/diseases/recdyqhJbtWIxkHxN 2/3 6/24/23, 2:28 PM Infantile hemangioma Pathway https://web.pathway.md/diseases/recdyqhJbtWIxkHxN 3/3