Dr. Kolachalam, Hemangiomas
What is a Hemangioma?
It is a collection of small blood vessels in or under the skin (subcutaneous), that often stains the skin bright red. A hemangioma usually becomes visible within the first few weeks of life and goes away by itself after about two years of age.
If the hemangioma is below the skin and does not have the typical skin stain, Dr. Kolachalam may suggest its surgical removal. Large hemangiomas or those near the eyes, nose, or genital area also may need surgical removal.
Treatment for Hemangiomas:
The first thing you should realize is that there are options for treatment. There is no reason in this day and age to accept that the only option available is to ‘leave it alone’ and wait for the hemangioma to ‘go away’.
Secondly, the most appropriate treatment plan needs to be individualized for each patient and each lesion. Therefore, similar lesions in different patients may be treated differently. Likewise, a given child may have more than one hemangioma and each of those may be treated differently.
What Dr. Kolachalam considers when deciding which treatment is best:
- Whether the hemangioma is proliferating or involuting
- Whether it is superficial, deep or compound
- The location of the lesion
- The age of the child.
In general, there are four potential treatment options which may be used singly or in combination.
- Observation – sometimes it is appropriate to see what happens. Different from the ‘leave it alone and it will go away’; it is a conscious decision to use a pre-determined period of time to observe how the birthmark changes.
- Steroids – These powerful medicines are the mainstay of medical treatment for hemangiomas. The goal is to slow down the growth of the lesion. Therefore, they are only useful during proliferation – treating an involuting hemangioma with steroids is not useful though it is commonly done.
- Lasers -The goal of laser treatments is to completely remove the lesion, set the stage for further treatments, treat complications or treat the inevitable broken blood vessels (telangiectasias) left behind as a hemangioma involutes. The pulsed dye laser (PDL) with a dynamic cooling device is the mainstay for treatment of the superficial vascular component of the hemangioma. It can be used to slow the proliferation, reduce the redness and set the stage for other treatments.
- Surgery – Similar to lasers, the goal of surgery is to remove the lesion completely set the stage for other treatments, or correct what is left after involution. Lesions are operable throughout proliferation or involution.