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Infantile hemangioma

Key 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.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
Refer the patient to a hemangioma specialist as soon possible, after identifying an infantile hemangioma as high risk.
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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.
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3.Medical management

Oral beta-blockers: offer oral propranolol as first-line therapy for patients with infantile hemangiomas requiring systemic treatment.
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  • Topical beta-blockers

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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).

5.Surgical interventions

Surgery: consider surgery as a treatment option in managing selected patients with infantile hemangiomas.

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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.