morphological type
hemangioma activity scale
visual analogue scale


Background. Infantile hemangioma (IH) is a neoplasm that is most common in childhood. Morphologically, hemangiomas are divided into superficial, deep and mixed, focal, segmental, indeterminate and multifocal. The course of IH includes phases of rapid growth followed by slow involution. The degree of involution of hemangioma is variable.  Hemangiomas can lead to the appearance of permanent deformities of soft tissues or functional disorders, especially when localized on the face and vital structures. Clinical heterogeneity of hemangiomas creates significant difficulties for physicians in resolving issues of treatment tactics. Specific characteristics of the clinical behavior of hemangiomas of various morphological types can be crucial in the choice of management tactics for such patients. 

Objectives. The aim of the work is to study the effect of different morphological types of hemangioma in children on the effectiveness of treatment of age-related clinical features. 

Subjects and Methods. The study group consisted of 100 children in age from birth to 6 years who have  hemangiomas of different morphological types and localizations and did not receive previous treatment. All research participants for hemangioma severity scale (HSS), hemangioma activity scale (HAS), visual analogue scale (VAS) before, during and after treatment were scored.  Serum levels sFas/sFasLs before and during treatment evaluated.  

Results. With increasing the child’s age, the indicator as for HAS reliably decreases for all types of hemangiomas. In all types of hemangiomas predominantly an active growth took place. An abortive growth in 10% of patients was noted.  For focal hemangiomas, the indicator of sFas decreases with age, and for multifocal hemangiomas it increases. In both cases, there is an increase in the sFasL indicator with increasing age of the child. In our study, in age group before 1 year in the factor structures, “age” factor was considered to be the main one and manifested by a decrease in the activity of hemangioma with an increase in the age of the child. Among children over 1 year age, during the course of treatment, the greatest contribution the “hemangioma severity factor”, the influence of which leads to a decrease in the cosmetic effect of hemangioma treatment against the background of its high severity and an increase in the indicator of apoptosis inhibition of sFas. The influence of the “treatment efficacy” factor leads to a decrease in its cosmetic effect and an increase in the severity of the manifestations of hemangioma against the background of blocking the manifestations of apoptosis. 

Conclusions. When starting treatment of hemangioma in the early stages, the cosmetic effect increases significantly. A decrease in sFasL in the younger age group may indicate a decrease or absence of apoptosis processes, which is clinically expressed by active proliferation. An increase in sFas in the older age group (over a year old) may indicate a blockage of apoptosis processes and, as a consequence, a slow regression of hemangioma.


Hinen, H. B., Trenor III, C. C., & Lee, L. W. (2020). Childhood Vascular Tumors. Frontiers in Pediatrics, 8.

Davila-Osorio, V. L., Iznardo, H., Roe, E., Puig, L., & Baselga, E. (2020). Propranololresistantinfantile hemangioma successfully treated with sirolimus. Pediatric Dermatology.

Blei, F. (2020). Nomenclature of Vascular Anomalies: Evolution to the ISSVA 2018 ClassificationSystem. In Vascular Anomalies (pp. 1-8). Springer, Cham.

Lee, M. T., & Maguiness, S. (2020). Infantile and Congenital Hemangiomas: Natural History,Complications, and When and How to Treat. In Vascular Anomalies (pp. 41-61). Springer, Cham.

Wadhwani, M., & Singh, R. (2020). Capillary hemangioma-A review. CLEVER Clinical andExperimental Vision and Eye Research, 3(1), 13.

Adams, D. M., & Ricci, K. W. (2018). Infantile hemangiomas in the head and neck region.Otolaryngologic Clinics of North America, 51(1), 77-87.

Atas, E., Koc, O., & Artik, H. A. (2017). Clinical features and treatment results in children withhemangioma. Turkish Journal of Pediatrics, 59(3).

Alsuwailem, A., Myer 3rd, C. M., & Chaudry, G. (2020, September). Vascular anomalies of the head and neck. In Seminars in Pediatric Surgery (p. 150968). WB Saunders.

Grzesik, P. & Wu, J. K. (2017). Current perspectives on the optimal management of infantilehemangioma. Pediatric Health, Medicine and Therapeutics, 8, 107.

Chamli, A., Aggarwal, P., Jamil, R. T., & Litaiem, N. (2019). Hemangioma.

Grzesik, P., & Wu, J. K. (2017). Current perspectives on the optimal management of infantilehemangioma. Pediatric health, medicine and therapeutics, 8, 107-116.

Strumila, A., Kazlauskas, V., Posiunas, G., Verkauskas, G., & Beisa, V. (2017). Infantilehemangioma: Predicting proliferation by infrared thermography. Medicina, 53(2), 85-89.

Rosenblatt, A., Mathes, E. F., & Rosbe, K. W. (2012). Infantile hemangiomas: from pathogenesisto clinical features. Research and Reports in Neonatology, 2, 55.

Padhiyar, J. K., Patel, N. H., Gajjar, T. P., Buch, M. D., Shah, Y. B., & Solanki, R. (2018). Efficacy and safety of propranolol on the proliferative phase of infantile hemangioma: a hospital-based prospective study. Indian Journal of Paediatric Dermatology, 19(3), 224.

O'Brien, K. F., Shah, S. D., Pope, E., Phillips, R. J., Blei, F., Baselga, E., ... & Treat, J. R. (2019). Late growth of infantile hemangiomas in children >3 years of age: A retrospective study. Journal of the American Academy of Dermatology, 80(2), 493-499.

Wildgruber, M., Sadick, M., Muller-Wille, R., & Wohlgemuth, W. A. (2019). Vascular tumors ininfants and adolescents. Insights into imaging, 10(1), 30.

Krowchuk, D. P., Frieden, I. J., Mancini, A. J., Darrow, D. H., Blei, F., Greene, A. K., ... & Pate,B. M. (2019). Clinical practice guideline for the management of infantile hemangiomas. Pediatrics, 143(1).

Fei, Q., Lin, Y., & Chen, X. (2020). Treatments for infantile Hemangioma: A systematic reviewand network meta-analysis. EClinicalMedicine, 26, 100506.

Wang, C., Li, Y., Xiang, B., Xiong, F., Li, K., Yang, K., ... & Ji, Y. (2017). Quality of life inchildren with infantile hemangioma: a case control study. Health and quality of life outcomes, 15(1), 221.

Chang, L. C., Haggstrom, A. N., Drolet, B. A., Baselga, E., Chamlin, S. L., Garzon, M. C., ... &Nopper, A. J. (2008). Growth characteristics of infantile hemangiomas: implications for management. Pediatrics, 122(2), 360-367.

Tollefson, M. M., & Frieden, I. J. (2012). Early growth of infantile hemangiomas: what parents'photographs tell us. Pediatrics, 130(2), e314-e320.

Mull, J. L., Chamlin, S. L., Lai, J. S., Beaumont, J. L., Cella, D., Rancour, E. A., ... & Haggstrom,A. N. (2017). Utility of the Hemangioma Severity Scale as a triage tool and predictor of need for treatment. Pediatric dermatology, 34(1), 78-83.

Wu, H. W., Liu, C., Wang, X., Zhang, L., Yuan, W., Zheng, J. W., ... & Fan, X. D. (2017). Topical application of 0.5% timolol maleate hydrogel for the treatment of superficial infantile hemangioma. Frontiers in Oncology, 7, 137.

Yildirimcakar, D., Demirsoy, U., Azizoglu, M., & Corapcioglu, F. (2020). Evaluation of ClinicalProperties and Treatment Responses of Infantile Hemangioma. Journal of Drugs in Dermatology: JDD, 19(12), 1156-1165.

Zhao, J., Huang, A. H., Rainer, B. M., Kryatova, M. S., Eghrari, A. O., Wang, J., ... & Cohen, B. A.(2019). Periocular infantile hemangiomas: Characteristics, ocular sequelae, and outcomes. Pediatric Dermatology, 36(6), 830-834.

Al-Mayoof, A. F., Joda, A. E., & Almushhadany, O. E. (2019). Propranolol therapy in infantilehemangioma: correlation of age and duration of treatment to the outcomes. Annals of Pediatric Surgery, 15(1), 1-9.

Chang, L., Lv, D., Yu, Z., Ma, G., Ying, H., Qiu, Y., ... & Lin, X. (2018). Infantile hemangioma: factors causing recurrence after propranolol treatment. Pediatric research, 83(1), 175-182.

Park, M., Jung, H. L., Shim, Y. J., Kim, H. S., Yoon, H. S., Park, S. K., ... & Choi, Y. B. (2020). Serum cytokine profiles in infants with infantile hemangiomas on oral propranolol treatment: VEGF and bFGF, potential biomarkers predicting clinical outcomes. Pediatric Research, 1-7.

Pavlidis, L., Spyropoulou, G. A., Papas, A., & Demiri, E. (2018). Urinary Excretion of MicroRNA126 Is a Biomarker for Hemangioma Proliferation. Plastic and Reconstructive Surgery, 141(2), 319e320e.

Ji, Y., Chen, S., Wang, Q., Xiang, B., Xu, Z., Zhong, L., ... & Qiu, L. (2018). Intolerable sideeffects during propranolol therapy for infantile hemangioma: frequency, risk factors and management. Scientific reports, 8(1), 1-7.

Schwartz, S. R., Blei, F., Ceisler, E., Steele, M., Furlan, L., & Kodsi, S. (2006). Risk factors foramblyopia in children with capillary hemangiomas of the eyelids and orbit. Journal of American Association for Pediatric Ophthalmology and Strabismus, 10(3), 262-268.

Ding, Y., Zhang, J. Z., Yu, S. R., Xiang, F., & Kang, X. J. (2019). Risk factors for infantilehemangioma: a meta-analysis.

Krowchuk, D. P., Frieden, I. J., Mancini, A. J., Darrow, D. H., Blei, F., Greene, A. K., ... Whelan, M. A. (2019). Clinical practice guideline for the management of infantile hemangiomas. Pediatrics, 143(1).

Yang, H., Deng, C., Shen, S., et al. (2006). Expression and significance of Bcl-2, Bax, Fas and caspace-3 in different phases of human hemangioma. J Huazhong Univ Sc Technol, 26, 402–404. doi: 10.1007/s11596-006-0405-y.

Adly, A.A, Ismail, E.A., Andrawes, N.G., Mahmoud, M.M., Eladawy, R. (2016). Soluble Fas/FasL ratio as a marker of vasculopathy in children and adolescents Cytokine, 79, 52-58. doi: 10.1016/j.cyto.2015.12.022.

Liao, H. F., Xu, J., Huang, J. (2010). Fas pathway is involved in dengue virus induced apoptosis of the vascular endothelial cells. J Med Virol, 82(8), 1392-1399. doi: 10.1002/jmv.21815.

Tiemann, L., & Hein, S. (2020). Infantile Hemangioma: A Review of Current PharmacotherapyTreatment and Practice Pearls. The Journal of Pediatric Pharmacology and Therapeutics, 25(7), 586-599.

Leaute-Labreze, C., Torres, E. B., Weibel, L., Boon, L. M., El Hachem, M., van der Vleuten, C. ... Rubin, A. T. (2020). The infantile hemangioma referral score: a validated tool for physicians. Pediatrics, 145(4).

Copyright for articles published in the journal is regulated by the License Agreement for the use of a scientific article in the journal, which is concluded between the author of the article (Licensor) and Kharkov National Medical University (Licensee, publisher of the journal "Inter Collegas"). The licensor grants to the Licensee a non-exclusive non-exclusive license for the use of the article (a license that does not exclude the use of the article by the Licensor and the issuance of licenses to others for use of this article) on the terms and for the period specified in the contract. The licensor (the author of the article) grants the Licensee the right to reproduce the article (publication in the journal "Inter Collegas", publication, duplication, duplication or other reproduction of the article without limiting the circulation of copies, each copy of the article must contain the name of the Licensor; Of general information, including the publication of the article in full or in part on the Internet on the journal page, the right to use the metadata of the article (titles, full names of authors, annotations, bibliography eskih materials) through the dissemination and communication to the public, processing and systematization, as well as inclusion in various databases and in-formational system).

The licensor grants the licensee the right to transfer, store and process his personal data (full name, scientific degree, academic title, place of work and position, contact information of the authors) with the purpose of including them in the database in accordance with the Law of Ukraine No. 2297 - VI "on protection of personal data" from 01.06.2010.

Personal data and metadata of the article are provided for their storage and processing in various databases and information systems, including them in analytical and statistical reporting, creating sound relationships between the objects of works of science, literature and art with personal data, etc. on unlimited territory. The licensee has the right to transfer the specified data for processing and storage to third parties provided that such a fact is notified with the provision of information about the third party (name and address) to the Licensor.