The Vascular Birthmarks Foundation
Dr. Linda's Blog Post: Early Intervention
January 9, 2017
Dr. Linda Rozell-Shannon
How soon should my child start treatment for their vascular birthmark? That is one of the most common questions VBF receives. This topic is so important that I hosted the first FACEBOOK LIVE WITH DR. LINDA on January 9th regarding this very topic.
Infantile Hemangiomas and the Port Wine Stains are the two vascular birthmark types that most parents write to us about regarding early intervention.
For the Infantile Hemangioma, it is critical that an accurate diagnosis be made and that treatment begins at or around the four-week well baby checkup. Why? Because this is when the “map” of the hemangioma is usually fully present and it is the best time to try to abort the growth. Most doctors have been trained to “ignore” these lesions and to tell the parents to “leave it alone, it will eventually go away.” However, this philosophy, which is referred to as “benign neglect,” is contrary to the mission and purpose of not only the VBF, but to many of the treatment experts that work with us.
Most parents have an instinct or “still small voice” that tells them something is “not right.” The doctors have told them to ignore the birthmark, yet something tells them not to. This causes them to research the word “hemangioma” on the internet, and that is how they find us. They soon discover that early treatment is critical for a good outcome. From our Find a Doctor list they find the closest expert to where they live and make an appointment. Early intervention for an Infantile Hemangioma can be laser, topical Timolol, or oral propranolol/hemangeol. It all depends on the size and/or severity of the lesion. For a hemangioma that is just emerging, the laser and topical Timolol can usually abort the growth. For a well circumscribed and large or ulcerating hemangioma, oral propranolol is the gold standard of treatment. Some lesions – very few, but some – do not respond to the beta blocker (propranolol and hemangeol are beta blockers). There can be many reasons for this such as improper dosage, misdiagnosis, or an angry aggressive non-responsive hemangioma. Hemangeol is the only FDA approved drug in the USA for the treatment of an Infantile Hemangioma. The key is to NOT allow this to get so large that surgery is the only option. Unfortunately for many cases, surgery becomes the only option.
Port Wine Stains also require early and frequent treatments. The PDL (pulse dye laser) remains the #1 choice for treatment. Laser treatments should begin as soon as possible. Many of the top laser experts in the world want to start treatment before the baby is one month old. Why? Because they respond much better to treatment, it is a much smaller area, and they will never remember it!!! Some doctors use anesthesia and some do not. It’s something every parent needs to explore.
Once you no longer see any clearance after two subsequent treatments it’s time to take a break because the laser is just not reaching the vessels. In time, the vessels will migrate to the surface of the dermis and the stain will once again respond to treatment.
Remember, early intervention is critical. As a parent, you have the right to insist on treatment or to get a referral to someone who will treat. The old “leave it alone” philosophy is no longer appropriate in this day and age when many treatment options are available to prevent these from growing or becoming worse.
For more information, watch the 60-minute discussion in this Facebook Live video replay.
Dr. Linda Rozell-Shannon