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Original Investigation |

Social Impact of Facial Infantile Hemangiomas in Preteen Children

Victoria A. Costa, BS1; Rachel Haimowitz, BS1; Yao I. Cheng, MS2; Jichuan Wang, PhD2; Robert A. Silverman, MD3; Nancy M. Bauman, MD4
[+] Author Affiliations
1Currently a medical student, School of Medicine, George Washington University, Washington, DC
2Children’s National Health System, Center for Translational Sciences, School of Medicine, George Washington University, Washington, DC
3Department of Pediatrics, Georgetown University, Washington, DC
4Children’s National Health System, Department of Otolaryngology, Head, and Neck Surgery, School of Medicine, George Washington University, Washington, DC
JAMA Otolaryngol Head Neck Surg. 2016;142(1):13-19. doi:10.1001/jamaoto.2015.2597.
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Importance  Involuted infantile facial hemangiomas (IHs) may adversely affect the social skills of children.

Objective  To assess the social impact of involuted facial IHs, with or without prior treatment, in preteen children.

Design, Setting, and Participants  An observational, cross-sectional study of social anxiety and skills in preteen children with facial IHs diagnosed during infancy. The study took place in an academic institution and a community dermatology practice between January 1, 2013, and July 30, 2014. Records on 236 children with IHs located in a cosmetically sensitive area were identified; of those, 144 potential participants (parents) were reached by telephone and mailed study packets. Thirty completed questionnaires were returned. Data analysis was performed from August 1, 2014, to September 7, 2015.

Interventions  The questionnaires included the following psychiatric scales: (1) Social Anxiety Scale for Children–Revised (SASC-R), completed by parents and children, including the domains of Fear of Negative Evaluation and Social Avoidance/Distress in New Situations (SAD-New) (higher scores indicate greater social anxiety), and (2) Social Competency Inventory (SCI), completed by parents, including the domains of Prosocial Behavior and Social Initiative (lower scores indicate poorer social competency).

Main Outcomes and Measures  Demographics, clinical details, and survey responses were collected. Analysis was conducted using t tests to compare scores for each survey domain with established normative data and between sex as well as between treatment vs nontreatment groups.

Results  Of the 144 potential participants, 30 (21%) responded. The mean age of the preteen subjects was 10.0 years (range, 5.4-12.9 years) with a 2:1 female to male ratio. Twenty-five children (83%) had a single IH, and the remaining 5 participants (17%) had multiple IHs, with at least 1 IH in a cosmetically sensitive area. The periocular region was the most common site of the IH (10 [33%]), followed by the nose (6 [20%]), cheek (5 [17%]), forehead (4 [13%]), lip or perioral region (4 [13%]), and ear (1 [3%]). Eighteen children (60%) had received treatment for their IH. With results reported as mean (SD), the SASC-R test showed that social anxiety of the children was not increased over normative data; however, those who did not receive IH treatment had significantly greater anxiety for new situations compared with those who received treatment (SAD-New: 15.5 [5.1] vs 11.5 [3.8]; P = .02). Results of the SCI scale indicated that the Prosocial Orientation domain score for the children was similar to normative data (3.96 [0.48] vs 3.89 [0.55], P = .50). Social Initiative domain scores were significantly poorer in children who did not receive treatment vs those who received treatment (3.45 [0.43] vs 4.03 [0.55]; P = .006).

Conclusions and Relevance  Preteen children with involuted, untreated facial IHs have higher Social Anxiety domain scores in new situations and decreased Social Initiative domain scores compared with children who receive treatment for facial IH. Although this study is limited by a small sample size, it raises important considerations for whether early treatment of facial IHs in cosmetically sensitive areas has a beneficial effect on social skills in preteens.

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Figure 1.
Enrollment

Study enrollment of 8- to 12-year-old children with a history of facial infantile hemangioma (IH).

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Figure 2.
Mean Scores on Social Anxiety Scale for Children–Revised

Higher scores indicate greater social anxiety. A, Participants (sample) with infantile hemangiomas (IHs) did not show greater Fear of Negative Evaluation (FNE) or Social Avoidance and Distress for New Situations (SAD-New). B, Children with untreated IHs had significantly higher scores for SAD-New compared with those with treated IHs. Error bars indicate SD.

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Figure 3.
Mean Scores on Social Competence Inventory Survey

A, Social Initiative domain scores were similar between participants (sample) and normative data but tended to be worse for participants in the Social Initiative domain. B, Social Initiative domain scores were significantly lower (worse) in children with untreated infantile hemangiomas (IHs) compared with those with treated IHs. Error bars indicate SD.

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