By Larry Hand
NEW YORK (Reuters Health) - Preteen children with untreated involuted facial infantile hemangiomas (IHs) experience social anxiety and decreased social initiative compared with children who received treatment, according to a new study.
"Babies who have hemangiomas, especially those that are on the face, may require treatment. Ideally those patients should be seen by individuals with vascular-anomaly expertise to make the decision whether to be treated," Dr. Nancy M. Bauman, of Children's National Health System, George Washington University, Washington, DC, told Reuters Health.
Dr. Bauman and colleagues sent questionnaires to parents of children born between 2000 and 2005 seen for IH at Children's National Medical Center or Virginia Dermatology Practice who had lesions in cosmetically sensitive areas.
They used questions from the Social Anxiety Scale for Children-Revised (SASC-R) to be answered by parents and children and the Social Competency Inventory (SCI) to be answered by parents.
Of 665 patients with an IH diagnosis during the study period, researchers identified 236 potential participants with periocular, cheek, nose, ear, lip, and forehead lesions. They were only able to reach 144 of those households by telephone, and of those, only 30 (21%) responded to the survey, the team reports online November 19 in JAMA Otolaryngology - Head & Neck Surgery.
All 30 completed the SASC-R surveys, and 29 completed the SCI survey.
Twenty-five (83%) children had single IHs and five (17%) had multiple IHs; 10 had lesions in the periocular area, six had nose lesions and five had cheek lesions.
Of all the respondents, 19 children had received treatment, 10 with prednisolone, six with prednisolone and/or surgery, and six with prednisolone and/or laser therapy.
Parents informed researchers that some children also had diagnoses of psychological or learning disorders, including two with attention deficit/hyperactivity disorder, one with anxiety, two with mild learning disabilities, and one with trouble deciphering social cues. Six parents also reported other medical problems.
Most untreated children had significantly higher scores for social anxiety (15.5 vs. 11.5, p=0.02). Untreated children also had lower, social initiative scores (3.45 vs. 4.03, p=0.006).
"This study uniquely explored the social anxiety levels and social competency skills of preteen, school-aged children with facial IH," the researchers write.
"Our study uniquely used two validated psychiatric instruments for social anxiety in children instead of the less specific health-related quality-of-life questionnaires," they add.
"Although reports from the 1950s advocated avoidance of treatment, assuming that all IHs involute nearly completely, we now recognize that most children have cosmetic sequelae of their IHs," they write.
The team concludes, "Although this study is limited by a small sample size, these results suggest that treatment should be considered for infants with IHs in cosmetically sensitive areas as it may decrease the risk of social inadequacies during the preteen years."
"We still recommend no treatment for many patients because hemangiomas will eventually involute," Dr. Bauman told Reuters Health. "But if they're on the face and have the risk of significant scarring once they are involuted, then I think it's a good idea to treat them. Our study showed that patients who had treated lesions had better social competency than those who were untreated."
SOURCE: https://bit.ly/1LoDtRv
JAMA Otolaryngol Head Neck Surg 2015.
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