Clinical SnaDshot
Neonatal Hemangiomatosis
Laura Yousenasna
The ''Clinical Snapshot" series provides a concise
examination of a clinical presentation including
history, treatment, patient education, and nursing
measures. Using the format here, you are invited to
submit your "Clinical Snapshot" to Dermatology
Nursing.
Description of Skin Lesion: Multiple heman-
giomas are scattered in a generalized distribution in a 1-
month old infant. These red papules and nodules range
in size from pinpoint to I cm (see Figure 1).
Location: Hemangiomatosis, defined as multiple
(typically five or more) hemangiomas, presents with
small cutaneous hemangiomas that may occur anywhere
on the skin or mucous membranes. In addition to cuta-
neous lesions, hemangiomatosis may involve visceral
organs, including, but not limited to, the liver, gastroin-
testinal tract, and brain.
Normal Course: As with traditional hemangiomas,
these hemangiomas may appear any time from birth
through the first few months of life. Normally heman-
giomas proliferate for an average of fi months to 1 year,
after which time they slowly regress (involute) over a
number of years. However, the small hemangiomas of
hemangiomatosis often do not show significant growth
and involute rapidly, sometimes within the first year.
Although the vast majority of infants with heman-
giomatosis have no complications, infants with signifi-
cant visceral involvement can rarely develop serious
complications. Cardiac failure may occur due to arterio-
venous shunting in patients with diffuse hepatic heman-
giomas. Gastrointestinal hemorrhage, neurologic seque-
lae, and other complications are also possible with vis-
ceral involvement, depending on location.
Etiology: The cause of hemangiomatosis is
unknown, but hemangiomas overall occur more fre-
quently in female, Caucasian infants. Multiple heman-
giomas are also strongly associated with prematurity and
multiple births, and occur more frequently in infants
whose mothers had placenta previa or preeclampsia
during pregnancy.
Hallmark of Disease: Traditional hemangiomas
can occur in various sizes ranging from pinpoint to cov-
ering an entire body segment and are subcategodzed as
localized or segmental. Localized hemangiomas are usu-
Laura Yousenasna, BSN, RN, is a Staff Nurse, Dermatology
Clinic, Texas Children's Hospital, Houston, TX.
86
Figure 1.
These red papules and nodules range in size from
pinpoint to 1 cm.
ally round papules and nodules, while segmental
hemangiomas are typically plaque-like and seem to
cover a region or territory of skin. Hemangiomas associ-
ated with hemagiomatosis are typically small (pinpoint
to 1 cm) in size and localized.
Treatment: No treatment is needed for uncomplicat-
ed lesions as all hemangiomas will show some degree of
improvement, and often completely resolve, over time.
Systemic corticosteroids are generallyfirst-linetherapy for
patients at risk for complications such as visual obstruc-
tion, cardiac failure, or respiratory compromise. A (i to 8
week course of oral steroids followed by a gradual taper is
generally used during the growth phase.
Patient Education: The diagnosis, prognosis, and
treatment expectations should be discussed with parents.
Many families are relieved to know that most heman-
giomas resolve without complications, but the slow
regression of hemangiomas should be emphasized.
Proper tapering of oral steroids and side effects of med-
ications should be discussed with parents of infants
receiving treatment.
Nursing Measures: Infants less than fj months of
age with five or more cutaneous hemangiomas should
be evaluated for possible visceral involvement.
Abdominal and head ultrasounds are appropriate
screening tools. Prompt recognition of cutaneous
hemangiomas can lead to early diagnosis of visceral
involvement. While most patients diagnosed with vis-
ceral involvement remain healthy, a small subset can
develop serious complications during the growth phase,
so monitoring is key, with intervention dependent on
the patient's clinical status. •
DERMATOLOGY NURSING/February 2007/Voi. 19/NQ. 1