RAPIDLY INVOLUTING CONGENITAL HEMANGIOMAS
By Gary M. White, MD
Several types of congenital hemangiomas occur.
- Rapidly involuting congenital hemangiomas or RICH
- Non-involuting congenital hemangiomas or NICH
- Partially involuting hemangioma or PICH
- The same GNAQ or GNA11 mutation is found in both NICH and RICH [Am J Hum Genet. 2016;98:789-95].
The RICH is a vascular papulonodule that is fully formed at birth. It may be a few to many centimeters in diameter. The head and neck are the most common sites. Ulceration may occur. Rarely, a RICH may be complicated by may present with transient thrombocytopenia and cardiac overload [Ped Derm 2014;31:402].
Lesions may rapidly involute within weeks or may do so over many months--up to 16 months. Rarely, lesions involute in utero. Some RICH only partially involute, leaving a PICH [JAAD 2014;70:899-903].
Ulceration, complicated by life-threatening hemorrhage may rarely occur [JAMA Derm 2015;151;422].
No treatment is needed, but surgery may be done for persistent, redundant skin.
Excellent response to prednisone. Dermatology Journal Online 14(4).
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