Birthmarks are a fact of life. Everyone is born with at least one or two marks that are unique to their own bodies. Infantile hemangiomas (IHs) – often referred to as strawberry marks – are the most common type of noncancerous growths that form due to an abnormal collection of blood vessels. But what happens when hemangiomas are located on the face or grow uncontrollably to cause pain or threaten a child’s health?
This was the case for Kendall, a healthy infant who was born in 2009 with a dime-sized strawberry mark on the left side of her head above her ear. Her parents didn’t think much about the mark; Kendall’s doctor told her parents it would shrink and disappear as she grew older. But two weeks later, another small spot appeared on her cheek. The hemangioma on her head began to grow rapidly. Within a month, the original spot on Kendall’s scalp was larger, rounder, began to scab and bleed, and was increasingly painful when touched.
The Path to UPMC Children’s Hospital
Kendall’s pediatrician referred her to the Pediatric Vascular Anomalies Center at UPMC Children's Hospital of Pittsburgh where physicians are trained to care for children with a wide spectrum of hemangiomas and their concomitant complications. For Kendall, her diagnosis of infantile hemangioma with ulceration and bleeding, combined with the location and size of her lesion, required more than a wait-and-see treatment. “Typically, infantile hemangiomas go away on their own,” explains Lorelei J. Grunwaldt, MD, director, Vascular Anomalies Center. “But if they are large and painful, it can be very hard on the child and the family. Large hemangiomas can also block the airways or eyes or cause large painful lesions if left alone.”
The Solution
Dr. Grunwaldt started Kendall on a long-term course of propranolol, a receptor blocker commonly used for cardiologic indications in young children that was known to speed the healing of ulcerations and the involution process. At the time of her treatment, UPMC Children's Hospital was one of the only facilities in the country to use propranolol for this type of treatment, which is now a standard of care in the treatment of infantile hemangiomas worldwide.
“Children’s was on the early end of the curve for this revolutionary treatment,” notes Dr. Grunwaldt.
Kendall’s parents, Dana and Matt, knew they made the right choice in bringing their daughter to Children’s.
“We decided to do the propranolol because we wanted to stop the growth and slow the process,” notes Dana. “We knew the drug was safe. We talked to many of the doctors about our situation and using the new drug.”
The Results
Within days of the initiation of propranolol treatment, there was a noticeable difference in the size of Kendall’s hemangioma. The improvement continued until almost complete involution was achieved.
“At first there was a slight flattening; within the first week it was noticeable. By the end of the first month, the spot was pretty much completely flat,” remembers Dana.
Five months later, the hemangioma was healed but still noticeable with significant scarring that resulted in a lack of hair growth in the area. To help in the cosmetics of Kendall’s hair loss, Dr. Grunwaldt did revisionary surgery to excise some of the scar tissue on the scalp – a decision predicated on the large size of the scar and its location on her head.
The results were excellent and Dana and Matt are still grateful to this day for the innovative treatment physicians gave their daughter five years ago.
“I could not get over the results; everything was outstanding,” says Dana. “Today you have to pull her hair back and really look for the scar. Kendall is a a happy child who we feel has been kissed by so many angels.”