Treatment and Therapy of HEMANGIOMA

Most of  hemangiomas without complications received conservative therapy, both capillary hemangioma, cavernous or mixed. This is caused by lesions that most will involute spontaneously. In many cases of hemangiomas which received conservative therapy had better results than surgical therapy is both functional and cosmetic. There are two ways of treatment in a hemangioma.


A.    CONSERVATIVE THERAPY
Naturally hemangioma lesions enlarged in the first months, then reaches a large maximum and spontaneous regression after it occurs around the age of 12 months, the lesion continued to regress until the age of 5 years. Superficial hemangiomas or strawberry hemangioma is often not treated. If a hemangioma is allowed to disappear, the results appear normal skin.

B.    Non CONSERVATIVE THERAPY.
Hemangiomas which require active therapy, such as hemangioma that grows on vital organs, such as the eyes, ears, and throat; bleeding hemangioma; an ulcerated hemangioma; hemangiomas with infection, hemangioma with rapid growth and tissue deformities.

1.    Compression Therapy:
There are two kinds of compression therapy can be used, they are continuous compression using an elastic bandage and intermittent pneumatic compression using the Wright Linear pump. Allegedly with the emphasis there will be discharge blood vessels will cause damage to endothelial cells which would cause the premature involution of hemangiomas.
2.    Corticosteroid therapy:
Criteria for treatment with corticosteroids are:
(1)    If involving one of the vital structures,
(2)    It grows quickly and destruction hold cosmetics,
(3)     In a mechanical hold one orifice obstruction,
(4)    There is a lot of bleeding with or without thrombocytopenia,
(5)    causes dekompensation cardiovascular.
Corticosteroids such as prednisone which make hemangioma regresses, ie to the form of strawberries, corpora cavernosa, and mix. The dose is 20-30 mg per day orally for 2-3 weeks and slowly lowered, the duration of treatment to 3 months. Therapy with corticosteroids in high doses will sometimes lead to regression of the lesions that grow rapidly. 

Hemangioma cavernosum which grows in the eyelid and interfere with vision are generally treated with steroid injections to reduce the size of the lesion rapidly, so that vision can be restored. Hemangioma cavernosum or mixed hemangiomas can be treated if the steroid is administered orally and direct injection in hemangioma. Peroral corticosteroid use in a long time can increase systemic infections, blood pressure, diabetes, stomach irritation, as well as stunted growth.
Sensitization of endothelial cells to catecholamines is the mechanism of intralesional corticosteroid injection. Therapy can occur even after enlargement of the lesion, it is temporary. The color change can be seen 2-3 days after injection and within 2-3 weeks of hemangiomas can be seen to shrink. The effectiveness of this type of therapy can usually be seen 2-3 weeks after therapy. But can also be seen after 2 months of therapy. Injection is not given to lesion but more deep in the tissues surrounding the lesion so that more space is available. Complications of this therapy, among others, can occur depigmentation and necrosis of fat. Injecting slowly with small doses can reduce the occurrence of  complications.
3.    Surgical treatment:
Incision surgery depends on the size and location of the hemangioma to be excised. Therefore radiological examination and other support is indispensable to accurately diagnose. The indication of surgical therapy on hemangiomas are:
(1)    There are signs that growth is too fast, for example, in a few weeks the lesion to be 3-4 times larger,
(2)    giant Hemangioma with thrombocytopenia,
(3)    There is no spontaneous regression, such diminution does not occur after 6-7 years.
Lesions located on the face, neck, hands or fast-growing vulva, may require local excision to control it. Embolization before surgery can be very useful if the hemangioma to be excised have a large size and location are difficult to reach with surgery. Embolization will shrink the size of the hemangioma and reduce the risk of bleeding during surgery.
4.    radiation therapy
Radiation treatment in recent years are now widely abandoned because:
(1)    The irradiation resulted in less well in children that bone growth is still very active,
(2)    Complications of malignancy that occurs in the long run,
(3)    Potential of fibrosis in the healthy skin that make difficult if the required action.
Although radiation is used extensively in the past to treat a hemangioma, but at present rarely used anymore because of long-term complications of radiation therapy, and the fact that most capillary hemangiomas will regress.
5.    sclerotic therapy
The therapy is administered by injecting the material sclerotic hemangioma lesions, for example by Namor rhocate 50%, 20% HCl kinin, Na-salicylate 30%, or hypertonic NaCl solution. However, this method is not preferred because of soreness and cause cicatrix.
Absolute alcohol is an ingredient that is often used in the treatment of sclerotic. This is due to the excellent ability to cause endothelial damage. Side effects that may occur on the injection of alcohol is the destruction of nerve tissue around, necrosis of skin, and toxicity of cardiovascular system.
6.    frozen therapy
Cool applications using liquid nitrogen. Considered quite effective given the type of superficial hemangiomas, but the therapy is rarely done because the reported cause cicatrix post-therapy.
7.    laser therapy
Irradiation with a laser performed using pulsed dye laser (PDL), which type of laser is considered particularly effective for this type of port-wine stain. This type of laser has advantages when compared with other types of lasers because of the effects are minimal keloid.
8.    embolization  therapeutic
Embolization is a technique to position the material is a thrombus into the lumen of blood vessels through the arterial catheter with fluoroscopy guidance. Embolization done when other therapeutic modalities can not be done or in preparation for surgery. Blockage of blood vessels may be permanent, semi permanent or temporary, depending on the type of materials used. Many of the embolization materials used, among other methacrylate spheres, balloon catheters, cyanoacrylate, silicone rubber, wool, cotton, gelatin sponge, polyvinyl alcohol sponge.
9.    interferon therapy
Interferon therapy works by inhibiting the growth of endothelial cells. Recombinant interferon alfa 2a or 2b is a second-line treatment in a hemangioma is very large and dangerous. Indications of the use of interferon therapy are:
(1)    No response after treatment with corticosteroids,
(2)    a contraindication by parenterally Corticosteroid long-term therapy,
(3)    the complications by corticosteroids,
(4)    the refusal of parents to therapy with corticosteroids.
In children who previously have received corticosteroid therapy, this dosage of corticosteroids should be lowered at interferon therapy. The dose of interferon is 2-3 mU/m2, injected subcutaneously once a day. The dose of interferon should always be tailored to the child's weight to prevent the proliferation of endothelial cells. Percentage of success of this therapy is 80% and can be seen after 6-10 months of therapy. Treatment with interferon is considered very effective at sufferers who experience Kassabach-Merritt syndrome. Young children who were treated with injections of interferon will have a fever for 1-2 weeks at the start of therapy. Giving acetaminophen 1-2 hours before the therapy can reduce symptoms. This therapy can cause complications include increased transaminases serum, neutropenia and anemia are temporary. The most dangerous complication is spastic diplegia, usually improved after termination of therapy, so that in children who received interferon therapy should be monitored development and neurological function at regular intervals.
10.    Chemotherapy
Vincristine is the other second-line therapy that can be used in children who do not successfully treated with corticosteroids and is also considered effective in children who suffer Kassabach-Merritt syndrome. Vincristine given intravenously with a success rate of more than 80%. Side effects of this therapy is peripheral neuropathy, constipation and hair loss. Cyclophosphamide is rarely used in a benign vascular tumor because it has a very large effect of toxicity ..
11. Antibiotics
Antibiotics are given to the ulcerated hemangioma. Also performed in a sterile wound care.