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    Top five treatment mainstays: Ulcerated pediatric hemangiomas

    Managing pain and complications



    1. Pain management was employed in three quarters of cases.

    "[Ulcerated] hemangiomas can be exquisitely painful," explains Irene Lara-Corrales. Some of the approaches to managing the pain associated with ulcerated hemangiomas include the use of acetaminophen, ibuprofen, topical lidocaine preparations, and oral opiate-derivatives such as morphine.4


    1. Infection control was used in 38% of cases.

    Antibiotic ointment and wound care will suffice to control most minor infections; however, in some cases, secondary infection from bacteria such as Pseudomonas can lead to hospitalization and intravenous antibiotic treatment.5


    1. Systemic therapy was used to reduce the lesion in about a third of cases.

    Oral beta-blockers have supplanted oral steroids as systemic treatments for hemangiomas, notes Dr. Lara-Corrales. In particular, propanolol has been the overwhelming first-line choice of beta blocker at most tertiary pediatric centres in North America, but Dr. Lara-Corrales and colleagues have opted to use nadolol as their first-line selection.

    "Nadolol has a longer half-life, and it allows for twice daily dosing instead of three doses per day," says Dr. Lara-Corrales. "That makes compliance easier to achieve for families."

    Another aspect of nadolol is that, unlike propanolol, it does not cross the blood-brain barrier. "Propanolol can disrupt sleep," notes Dr. Lara-Corrales.

    Research in adult patients suggests that the use of propanolol can have an adverse effect on memory, notes Dr. Lara-Corrales. While there is no research in the pediatric setting that shows this impact with the beta-blocker, Dr. Lara-Corrales and her colleagues decided it's prudent to look for an alternative to propanolol to use in infants.

    Dr. Lara-Corrales and colleagues completed and published a study reporting their experience with nadolol, comparing it to a retrospective cohort of patients treated with propanolol.6

    1. Suppression of bleeding was required in 2% of cases.7

    When ulcerated hemangiomas bleed, the bleeding is generally not major and can be managed with wound compression.5

    Parents should be warned that there may be a residual scar after treatment of an ulcerated hemangioma, cautions Dr. Lara-Corrales.


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