Understanding the Controversies in Lasers and Infantile Hemangiomas

“When you have a hemangioma—a infantile hemangioma that's larger, more what we call segmental, not round, patterned, often syndromic—what is the role of laser in those children? And especially the timing—should we be thinking about potentially lasering earlier than we traditionally have?” Denise W. Metry, MD, FAAD, a dermatologist in South Texas practicing at Driscoll Children's in Corpus Christi, tackled those and other controversial issues in lasers and infantile hemangiomas at the 2025 American Academy of Dermatology Annual Meeting.¹

The use of lasers in treating infantile hemangiomas, particularly larger, segmental lesions, remains a topic of debate among dermatologists, Metry told Dermatology Times in an exclusive interview. Although laser therapy has been a mainstay in managing port wine birthmarks, its role in segmental infantile hemangiomas has historically been limited due to concerns over ischemia and ulceration, she explained.

“There is some data from about 20 years ago that really discouraged people from lasering those types of hemangiomas early, because the laser technology just wasn't where it is today,” Metry said. “We've now got cooling devices, we've got beta blockers, and we know what the risks are in these babies, which are really ischemia and ulceration.”

Ultimately, she told attendees they need to balance laser use pros with its cons.

Although it can be difficult to distinguish between a port wine birthmark and a segmental infantile hemangioma, early differentiation is crucial, as treatment approaches differ significantly, Metry added. She reminded attendees that port wine birthmarks are well-demarcated, solid, and uniform, whereas hemangiomas tend to be more telangiectatic and evolve over time. Misclassification can lead to inappropriate treatment plans.

In contrast to port wine birthmarks, hemangiomas are dynamic lesions. “We know hemangioma tissue occurs as a result of hypoxia, and there are probably vascular changes that explain that. They're prone to ulceration and ischemia,” she said.

Fortunately, Metry noted there are great resources for dermatologists treating these lesions, such as the Hemangioma Investigator Group’s website (hemangiomaeducation.org) as well as journal articles.

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Reference

1. Metry DW. Laser for Complicated Segmental Infantile Hemangiomas: Who, What, Where, and Why Presented at: the American Academy of Dermatology Annual Meeting; March 7-11; Orlando, Florida.