Infantile Hemangioma Management Improved via Telemedicine

Infantile hemangiomas (IH) can be efficaciously assessed and managed via telemedicine by physicians confident in their infantile hemangiomas management expertise, according to study findings published in Pediatric Dermatology. Rare cases in which beta-blocker therapy is warranted can still be managed via telemedicine, except for those patients with therapy risk factors.

The extensive growth of telemedicine prompted by the COVID-19 pandemic led researchers to evaluate treatment of patients with infantile hemangiomas by specialists who are using telemedicine. Study objectives were physician-perceived effectiveness and the identification of issues blocking appropriate care via telemedicine.

In the cross-sectional study that included 281 patients from 15 medical centers worldwide, investigators interviewed specialists from March through September, 2020, regarding their experience using telemedicine in their initial assessment of infantile hemangiomas. Median time from referral to evaluation was more than  2 weeks. Physician self-reported confidence in conducting these evaluations using telemedicine was 95% (IQR, 90.0-100.0). For 102 patients, physician confidence was self-reported below 90% and for 21 patients below 70%.

Most telemedicine evaluations were by video communication with photographs or audio communication with photographs. When photographs were not initially available, they were requested in more than half of the cases. More than one-half of follow-up evaluations conducted via video or audio had photographs available, and nearly one-quarter of follow-up evaluations were conducted in person.

The majority of patients were female and White. Hemangioma location was most frequently the head or neck (59.3%), followed by the trunk and extremities (47.8%). More than one-third of patients presented with a high-risk hemangioma, and among those patients the majority faced permanent disfigurement or scarring. Several faced functional impairment, vision impairment, difficulty feeding, or risk of ulceration, and 1 patient experienced a life-threatening situation.

Study limitations include the data being derived from a narrow timeframe, the lack of assessment of parental experiences, the inability to generalize results to physicians who treat infants but are not experts in hemangioma cases, and data bias.

Investigators observed that the experts preferred telemedicine visits to include photographs, and that the clinical experts in infantile hemangiomas management were, “confident in their abilities to assess and manage [infantile hemangiomas] via telemedicine including initiating treatment in patients without risk factors for beta-blocker therapy.” Researchers believe their data suggest wait times in infantile hemangiomas management may be reduced and that neglected locales could see an improvement in specialist care through use of teledermatology.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Kittler NW, Frieden IJ, Abuabara K, et al. Successful use of telemedicine for evaluation of infantile hemangiomas during the early COVID-19 pandemic: a cross-sectional study. Pediatr Dermatol. Published online June 22, 2022. doi:10.1111/pde.15040