It is known that the hemangioma has spontaneous regression course. Many therapeutic modalities are available including, systemic steroid, local intralesional steroid injection, oral propranolol and atenolol.
Maher Al Zaiem, A very interesting question.
For Facial hemangioma the treatment has to be individualized. Various factors to be taken into account are the site, functional impairment, obstructing vision, or incidence of complications like bleeding, ulceration or infection. A trial of Cx Rx is always in the book if the above factors are favorable. A clinical image at the initiation of Cx MX will also guide us to decide any change in the plan during follow-up. However, if Cx Mx is not without risk, all options you have mentioned can be used with almost equal long term results [provided the dose & frequency are complied].
Anjan
In our clinic most parents opt for active management for their infant's facial haemangiomas, even relatively small ones. We use oral propranolol 1mg/kg/day in 3 divided doses. Best results obtained if started in the first three months of life. Any haemangioma impacting on visual fields should be treated early. We monitor the rate of volume shrinkage with a 3D camera.
I allways start With PROPANOLOL as soon as possible at 3 mgs/kg/ day .
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