Infantile hemangioma. Part 2: Management.

The majority of infantile hemangioma (IH) can be managed conservatively but for those requiring active treatment, management has been revolutionized in the last decade by the discovery of propranolol. Patients that may require active intervention should receive specialist review, ideally before five weeks of age to mitigate the risk of sequelae. The majority of infants can be commenced on propranolol in the outpatient setting and the most frequently employed dosing regimen is 1mg/kg twice daily. In the future, β-blockers with a more selective mechanism of action, such as atenolol, show some promise. In recalcitrant lesions, systemic corticosteroids or sirolimus may be considered and for small, superficial IH, topical timolol maleate or pulsed dye laser may be considered. Where IH involute with cutaneous sequelae a range of interventions have been reported including surgery, laser and embolization. IH have a well described clinical trajectory and avail themselves to diagnosis and management via telemedicine. Algorithms have been constructed to stratify those patients who can be managed remotely from those who warrant in-person review during the COVID19 pandemic.