Clinical Characteristics, Management, and Complications of Infantile Hemangiomas Involving the Ear and Periauricular Region

BACKGROUND: Despite advances in IH research across various anatomical sites, studies focusing on IH involving the ear and periauricular areas remain scarce. OBJECTIVE: To analyze the clinical characteristics, management, and outcomes of IH involving the ear and periauricular area. METHODS: Multicenter, retrospective study of patients with IH involving the ear and periauricular area across seven tertiary referral centers between 2001 and 2021. Data analyzed included patient demographics, IH location, management practices, Hemangioma Severity Scale (HSS) scores, and American Academy of Pediatrics (AAP) IH risk categories. RESULTS: A total of 305 patients met the inclusion criteria. Management decision information was available in 250 patients. Active intervention was pursued in 80% of the patients with available management information. The risk of anatomic deformity was the most common indication for treatment (72%), followed by ulceration (18%) and the risk of functional impairment (17%). Systemic beta-blockers were used in 48% of patients, followed by topical corticosteroids (46%) and topical timolol (32%). Treatment with a systemic beta-blocker was associated with a significantly higher HSS score (median 15.5, IQR: 12-20) compared to patients treated with topical therapy (median 10, IQR: 8-12). CONCLUSIONS: Given their location and potential for anatomic deformity and functional impairment, ear and periauricular IH may require intervention. A majority of patients in this cohort required treatment, most commonly for risk of anatomic deformity. The study is limited by the retrospective design and inclusion of patients seen before beta-blockers were available for IH management.