Cutaneous hemangiomas in children. Diagnosis and conservative management

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Abstract
During the 7 year period that 210 children with 336 involuting hemangiomas were observed, active treatment was not used. Management consisted of close observation of the birthmark to assess its growth pattern and reassurance of the parents that it will disappear unaided. The physician''s attitude, his interest in the problem, and the parent-physician relationship were most important. We found that the majority of congenital cutaneous hemangiomas involute spontaneously. This study revealed that strawberry, cavernous, and mixed hemangiomas regressed as follows at age 3 years, 30%; by 4 years, 60%; and by age 7 years, 76%. The end results, which should be measured by years (not by months) have been excellent cosmetically. Complications were common (56%) in a group which was treated actively, and were uncommon (5%) in our group whose hemangiomas involuted spontaneously. Careful follow-up showed no evidence of an abnormal reaction in the parents nor a behavior disturbance in the child. Since the majority of hemangiomas of early childhood will disappear, physicians are urged to manage them by the art of intelligent, planned neglect and masterful inactivity.

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