Application of color Doppler ultrasound in the treatment of infantile hemangioma by applying timolol combined with Cynergy dual-wavelength laser : Application of color Doppler ultrasound in the treatment of infantile hemangioma.

Abstract

To assess the utility of color Doppler ultrasound in guiding the treatment of infantile hemangiomas using a combination of topically applied timolol and Cynergy dual-wavelength laser. We selected 92 hemangioma patients from our outpatient clinic between March 2022 and September 2023. According to the Guidelines for Diagnosis and Treatment of Hemangiomas and Vascular Malformations (2019 edition), laser therapy is suitable for superficial localized or sporadic lesions, combined treatment or natural resolution of residual skin hemangioma lesions, remaining loose and uneven skin.All the patients in our group met the guidelines for Diagnosis and Treatment of hemangiomas and vascular malformations (2019 edition). The risk grade was medium risk and low risk, medium risk: hemangiomas on both sides of the face, scalp, hands and feet, with disfigurement risk and low risk of functional impairment; Hemangiomas in the body folds (neck, perineum, underarm), with a high risk of ulcer formation; Segmental hemangiomas > 5 cm- risk of ulcer formation on trunk, limbs, and skin, and permanent remains. Low risk: Trunk, limbs (not obvious), low risk of disfigurement and functional impairment. According to guidelines for moderate risk hemangiomas: Treat them early. Early and weak lesions can be given topical β-blockers, or pulsed dye laser; In the course of treatment, if the tumor growth cannot be controlled, the high-risk hemangioma treatment regimen should be followed. Low-risk hemangioma: If it is stable, follow up or try topical drugs; If the tumor is growing rapidly, the medium risk hemangioma treatment regimen is followed.These patients were divided into two groups, A and B. In group A, color Doppler ultrasonography was conducted, and patients were categorized into three groups based on their blood flow signals identified through color ultrasound. Among the 70 cases in group A with distinct blood flow signals, laser parameters were adjusted, and topical timolol was administered. In group B, the family members of the patients were reluctant to accept color ultrasound examination due to poor family conditions and the patient's uncooperation during color ultrasound examination,22 cases received direct treatment with topical timolol and Cynergy dual-wavelength laser upon hospital admission without undergoing ultrasound. The time gap between these treatments was one month. Both groups were followed up for one month to compare treatment effectiveness, adverse effects, and treatment durations. A total of 92 patients were included in this study, with 70 cases in group A (average age 4.05 ± 2.51 months) and 22 cases in group B (average age 4.00 ± 2.33 months). Hemangioma blood flow signals in group A were categorized as follows: no blood flow, sparse blood flow, and moderate blood flow in groups A1, A2, and A3, respectively. The effectiveness rate in group A was significantly higher than that in group B (90.0% vs. 72.7%, U = 637, P = 0.044). Group A exhibited lower adverse effect rates compared to group B (n = 14 [20.0%] vs. n = 9 [40.9%], U = 609, P = 0.049). Furthermore, the number of treatments showed a statistically significant difference (F = 26.830, P = 0.00) between the two groups. Doppler ultrasonography proves valuable in assessing the clinical effectiveness of hemangiomas. Future research may determine its ability to predict the number of laser treatments required.