title: Early growth of infantile hemangiomas: what parents' photographs tell us.
abstract: OBJECTIVE
  Infantile hemangiomas (IH) are recognized as growing rapidly during the first months of life, but details of early growth before 3 months of age have not been well-characterized. Our goal was to study early IH growth by using parental photographs of infant children with facial IHs to better understand early hemangioma growth, with the aim of improving guidance for physicians and parents of infants with high-risk IH.
  
  
  METHODS
  Serial images of 30 infants showing IH at intervals of 1 to 2 weeks up to 6 months were analyzed for characteristics of color, thickness, and distortion of anatomic landmarks. The presence or absence of an IH precursor at birth was noted. Mean scores per age interval were compiled. Results were analyzed by using signed rank test. An assessment of "optimal time for referral" was made.
  
  
  RESULTS
  IH growth was nonlinear; most rapid growth occurred between 5.5 and 7.5 weeks of age. The mean "optimal age for referral" was 4 weeks of age. Hemangioma precursors were present at birth in 65% of patients.
  
  
  CONCLUSIONS
  The most rapid hemangioma growth occurs before 8 weeks of age, much earlier than previously appreciated. Specialty evaluation and initiation of treatment, however, typically occur after the age of most rapid growth. Our findings suggest a need for a paradigm shift in the timing of referral and initiation of treatment of high-risk IH so that therapy can be initiated before or early in the course of most rapid growth, rather than after it is already completed.
authors: Departments of Dermatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. tollefson.megha@mayo.edu
authors: Megha M
authors: MM
authors: Tollefson
authors: Ilona J
authors: IJ
authors: Frieden
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000367:Age Factors; D004200:Diseases in Twins / Q000473:pathology / Q000628:therapy; D005153:Facial Neoplasms / Q000473:pathology* / Q000628:therapy; D005260:Female; D006391:Hemangioma / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000473:pathology / Q000628:therapy; D054025:Lasers, Dye / Q000627:therapeutic use; D008297:Male; D017711:Nonlinear Dynamics; D010781:Photography; D011433:Propranolol / Q000008:administration & dosage; D012017:Referral and Consultation; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology* / Q000628:therapy; D013999:Timolol / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D013999:Timolol; D011433:Propranolol