Infantile hemangiomas: risk factors for complications, recurrence and unaesthetic sequelae

An Bras Dermatol. 2022 Jan-Feb;97(1):37-44. doi: 10.1016/j.abd.2021.05.009. Epub 2021 Nov 27.


Background: Infantile hemangiomas (IH) occur in approximately 4% to 10% of the pediatric population. The identification of clinical subtypes and conditions that indicate increased risk for complications is essential for therapeutic success.

Objectives: To identify risk factors for complications, recurrence and unaesthetic sequelae.

Methods: Retrospective cohort of patients with infantile hemangiomas undergoing follow-up at the Dermatology Service of Universidade Federal de Ciências da Saúde de Porto Alegre, between 2006 and 2018.

Results: 190 patients were included; 24% had some type of complication, ulceration being the most frequent, and 86% required treatment. On correlation, ulceration was statistically related to mixed IH (p = 0.004), segmental IH (p < 0.01) and location in the gluteal region (p = 0.001). The mean time of treatment with propranolol was 12.7 months. Patients with PHACES syndrome and segmental infantile hemangioma required longer treatment (p < 0.001 and p = 0.0407, respectively), as well as those who started treatment after five months of life (p < 0.0001). Recurrence occurred in 16.6% of the treated patients, all-female; 94% were located on the head and neck (mainly on the upper eyelid, cyrano, S3 segment, and with parotid involvement); 61% and 38.8% were of the mixed and deep subtypes, respectively. Approximately 1/3 of the patients had some unaesthetic sequelae.

Study limitations: As this is a retrospective study, data and photos of some patients were lost.

Conclusions: Mixed and segmental hemangiomas are risk factors for ulceration and sequelae. Recurrence occurs more often in females and segmental hemangiomas. Segmental infantile hemangioma and PHACES syndrome require a longer time of treatment. Specific protocols are required for infantile hemangiomas with a high risk of recurrence.

Keywords: Hemangioma; Propranolol; Recurrence; Risk factors; Scars.

MeSH terms

  • Child
  • Female
  • Hemangioma* / drug therapy
  • Hemangioma* / epidemiology
  • Humans
  • Infant
  • Propranolol / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Skin Neoplasms*
  • Treatment Outcome


  • Propranolol