Highlights of This CPG

• IH growth characteristics are different than once taught.
 ○ Most rapid IH growth occurs between 1 and 3 months of age.
 ○ Although IHs involute, this process may be incomplete, leaving permanent skin changes that may be life altering. This is especially true for IHs that are thick.
 ○ There is a window of opportunity to treat problematic IHs. Consult early (by 1 month of age) for lesions that are potentially high risk because of the following associations (Table 3):
  ■ potential for disfigurement (the most common reason treatment is needed);
  ■ life-threatening complications;
  ■ functional impairment;
  ■ ulceration; and
  ■ underlying abnormalities.
• Oral propranolol is the treatment of choice for problematic IHs that require systemic therapy.
• Topical timolol may be used to treat some thin and/or superficial IHs.
• Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution. They may be used earlier to treat selected IHs.