Under what circumstances do childhood vascular anomalies become dermatologic emergencies?

The most common vascular anomalies (about 3% of births) that have the potential to become dermatologic emergencies are infantile capillary hemangiomas. These lesions can be present at birth (approximately 20%) but more often develop over the first several weeks of life. Infantile hemangiomas have a rapid growth phase, during which they rapidly enlarge, and then they regress.

Most commonly, these tumors are only a cosmetic problem, but if they occur around the eyes or in the oral cavity (Fig. 64-6), they can cause significant morbidity and mortality. Some ophthalmologists suggest that even a few days of obstructed vision in a newborn can inhibit normal visual development. Therefore, an infantile hemangioma that may block an infant’s visual fields should be treated aggressively. Likewise, enlarging infantile hemangiomas of the upper respiratory tract and oral cavity can result in acute emergent situations and must be treated early in their course. In rare cases, large hemangiomas can also produce high-output cardiac failure.