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Clinical Characteristics, Morphologic Subtypes, and Their Relationship to Race, Ethnicity, and Sex

Katarina G. Chiller, MD,MPH; Douglas Passaro, MD,MPH; Ilona J. Frieden, MD

Arch Dermatol. 2002;138:1567-1576.

Background  Hemangiomas of infancy vary widely in appearance, size, and depth of cutaneous involvement. There is currently no standard classification system for these lesions. While they occur in any race, an increased incidence occurs in girls, light-skinned whites, and premature infants, especially those weighing less than 1500 g. Other epidemiologic and demographic factors have not been well characterized.

Objective  To determine any correlations between hemangioma subtype and anatomic location with demographic factors, complications, and other associated anomalies.

Design  Retrospective chart review of 327 patients with hemangioma of infancy seen between 1997 and 2000 in an ambulatory referral center.

Main Outcomes Measures  Demographic and gestational information, lesion size, associated anomalies, complications, treatments, and outcomes were analyzed together with classification of hemangiomas into 4 groups: localized, segmental, indeterminate, and multifocal. Subtypes were correlated with race and ethnicity, the incidence of complications, and overall outcome.

Results  Of 472 hemangiomas (327 patients), 339 (72%) were localized, 84 (18%) were segmental, 37 (8%) were indeterminate, and 12 (3%) were multifocal (8 or more noncontiguous lesions). Segmental lesions were larger and were more frequently associated with developmental abnormalities. They also required more intensive and prolonged therapy and were associated with more complications and a poorer overall outcome (P<.001). Lesions on Hispanic patients were more likely to involve mucous membranes, to be segmental (P<.004), to be associated with abnormalities (P = .05), especially PHACE syndrome (P = .05), and to have more complications (P = .01). Increased incidence of segmental hemangiomas was the only factor in Hispanic infants associated with complications, more extensive treatment, or associated anomalies.

Conclusions  Hemangiomas of infancy can usually be classified as localized, segmental, indeterminate, and multifocal, based on clinical features. Segmental lesions have a higher frequency of complications and associated abnormalities, and this type of hemangioma seems to present with increased frequency in Hispanic infants.

From the Departments of Dermatology (Drs Chiller and Frieden) and Pediatrics (Dr Frieden), University of California, San Francisco; and the Department of Epidemiology, University of Illinois, Chicago (Dr Passaro). Dr Chiller is now with the Department of Dermatology, Emory University, Atlanta, Ga.

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