We read with great interest the article published by Chang et al in
the August 2008 issue entitled “Growth Characteristics of Infantile
Hemangiomas: Implications for Management”. Infantile Hemangiomas (IHs)
management may be difficult and often needs a multidisciplinary approach.
They vary widely from small growing lessions to large, function-
threatening tumors. In this article, the authors find out that most IHs
growth occurs before 5 months, yet 5 months was also the mean age at first
visit to a specialist. The authors conclude that those IHs needing
specialty care should be referred and seen by a specialist as early as
possible within this critical growth period. For pediatricians and primary
care providers, this information on hemangioma growth and referral
patterns is a key factor for its management1,2.
Store-and-forward teledermatology (SFTD) has demonstrated to be an
effective, accurate, reliable, and valid approach for the routine
management of patient referrals in skin cancer and pigmented lesion
clinics2. It has generally demonstrated high levels of concordance in
diagnosis and management plans compared with face-to-face consultations3.
A SFTD triage system aimed at the selection of patients with vascular
anomalies including IHs was implemented in 2008 at the pediatric
dermatology unit of our public university hospital and at ten primary care
centers. The facility currently covers a total population of 876.654
inhabitants (83.268 of them 14 years old or younger) from a southern
spanish province comprising 5 to 100 kms away from the hospital. Nowadays
it has turned into an essential complementary tool for our daily clinical
practice. Pediatricians working in those primary care centers received
specific formation in vascular anomalies. One of the project objectives
was to evaluate if SFTD system for children with IHs could shorten the
time of first specialized attention. A total of 121 children born after
July 31st 2009 presenting 164 IHs were attended between 1st August 2008
and 31st July 2009. Sixty of those children (81 IHs) were referred by
teledermatology. Preliminary results showed that children with IHs
referred by teledermatology were first evaluated by a pediatric
dermatologist with a mean age of 3,5 months, while those referred to the
pediatric dermatology unit by the usual way were first evaluated by the
specialist at a mean age of 5,9 months (t-test, p< 0,002).
These preliminary results of an on-going multicenter, longitudinal,
descriptive and evaluation study show that SFTD for IHs could be a very
useful tool to shorten first specialized attention times and may result in
a reduction of complications derived from IHs who need specialty care.
References
1. Chang LC, Haggstrom AN, Drolet BA et al. Growth Characteristics of
Infantile Hemangiomas: Implications for Management. Pediatrics 2008; 122:
360-7.
2. Beth A, Drolet MD, Elizabeth A et al. Infantile hemangiomas: an
emerging health issue linked to an increased rate of low birth weight
infants. J Pediatr 2008; 153: 712-5.
3. Moreno-Ramirez D, Ferrandiz L, Nieto-García A et al.
Teledermatology as a filtering system in pigmented lesion clinics. Arch
Dermatol 2007;143:479-83.
4. Hsiao J, Oh D. The impact of store-and-forward teledermatology on
skin cancer diagnosis and treatment. JAAD 2008; 59: 260-267.
Conflict of Interest:
None declared
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