In this video blog, Jennifer Huang, MD, discusses highlights from her lecture, Diagnosis and Management of Infantile Hemangiomas, on July 27, 2024, during the inaugural Elevate-Derm Alliance Summer Conference at the Westin Copley Place in Boston, Massachusetts.

In this video

Dr. Huang frames the central question for general dermatology providers as "can I manage this patient, or do I need to refer?" — noting that pediatric dermatology simply doesn't "have the bandwidth to see every child with an infantile hemangioma." Thin, superficial lesions in non-cosmetically-sensitive areas that aren't ulcerated or affecting function can stay in the practice with reassurance and observation, and patients on topical timolol can often be managed without referral. She reserves referral for hemangiomas needing oral propranolol without adequate heart rate, blood pressure, and weight monitoring, and urgently refers segmental or regional lesions that may signal internal vascular anomalies requiring imaging.

On treatment, she reserves topical timolol for very thin (under 1 mm), bright-red superficial hemangiomas, following cosmetically sensitive cases back within two to three weeks to catch proliferation early. With oral propranolol she watches most for respiratory distress and hypoglycemia — using caution in infants under six weeks, preemies, and those with a family history of asthma — plus sleep disturbance, and stresses that the goal is to stop growth, not shrink the lesion, so "the earlier the referral, the better."

  • Keep thin, superficial hemangiomas in non-sensitive areas that aren't ulcerated or affecting function — reassurance and observation are enough. Refer when oral propranolol, close monitoring, or workup for internal anomalies is needed.
  • Use topical timolol for bright-red, very vascular superficial hemangiomas under 1 mm in height; in cosmetically sensitive spots, follow up in two to three weeks to be sure it isn't proliferating.
  • With oral propranolol, the beta-blocker heart rate and blood pressure effects are usually infrequent and asymptomatic — the bigger concerns are respiratory distress/bronchoconstriction and hypoglycemia, especially in infants under six weeks, preemies, and those with reactive airway disease.
  • Sleep disturbance is common on propranolol; consider stopping or switching beta-blockers when a baby is inconsolable and waking hourly, well outside their normal overnight behavior.
  • Treat early: peak growth is typically four to eight weeks of life, and the aim of propranolol is to prevent enlargement rather than reverse it — though deeper hemangiomas grow later and may warrant watchful waiting.