Infantile hemangiomas of the nose develop more complications than those at all other body sites combined, according to a report published in Pediatric Dermatology.

In what they described as the largest study to date to assess nasal infantile hemangiomas, researchers assessed which traits are associated with complications and predict residual skin changes at the age of 5 years. “Nasal infantile hemangiomas pose an immediate risk of airway obstruction because infants are obligate nasal breathers, and may have long-term functional and psychosocial consequences if involution is incomplete or development of surrounding structures, such as nasal cartilage, is compromised,” said Maria S. Kryatova of the departments of pediatrics and dermatology, Johns Hopkins University, Baltimore, and her associates.

The investigators identified all patients younger than 18 years who had been treated at their academic referral center for nasal infantile hemangiomas between 2001 and 2014. They performed retrospective chart reviews, which included photographs, for 89 participants. The parents of 63 of these children were interviewed when the participants reached a median age of 5 years and provided comparison photographs taken at their entry into kindergarten.

Thirty-five children (39%) developed one or more complications at some time during follow-up, including airway compromise, compression, or functional impairment; ulceration; visual obstruction or ocular compression; and infection. In comparison, the Hemangioma Investigator Group has previously reported a 24% overall rate of complications at all body sites. Similarly, the proportion of study participants who received at least one type of treatment (propranolol, oral steroids, pulsed dye laser, surgery, topical timolol, intralesional corticosteroids, yttrium-aluminum-garnet laser, carbon dioxide laser, or fraxel laser) was markedly higher (80%) than that reported previously by the Hemangioma Investigator Group for all body sites (38%).

“Our study is the first to report a significant association between [the hemangioma’s location on the nose] and depth. Lesions on the nasal dorsum are unlikely to be deep, whereas nasal tip lesions are unlikely to be superficial. Deep vertical growth may be limited by underlying nasal bone in the dorsum but less so by the soft tissue of the nasal tip.” Alternatively, as suggested by other investigators, an embryologic explanation is also possible – “the fusion lines between neural crest–derived mesenchyme and ectoderm-derived nasal placodes may have different properties in the vicinity of the nasal dorsum and nasal tip that predispose them to the development of superficial and deep hemangiomas, respectively,” Ms. Kryatova and her associates reported ( Ped Dermatol. 2016;33[6]:652-8 ).

Segmental- and indeterminate-type lesions were more likely than focal-type lesions to develop ulceration, compression, or functional obstruction, and mixed-depth hemangiomas were more likely than deep or superficial hemangiomas to ulcerate. Overall, the lesions had involuted by kindergarten age in 70% of the study participants but persisted in 30%, and most of the children with involution showed residual skin changes such as telangiectasia (14 children), fibrofatty tissue (11 children), and scarring (9 children).

These findings show that a multicenter study to expand on these conclusions and to determine the best treatment algorithm for nasal infantile hemangiomas is warranted, the investigators added.