# Bridging the Gap: Infantile Hemangioma Care Variability Among Pediatric Care Physicians in Greece

## TL;DR

Greek pediatricians and GPs show inconsistent management of infantile hemangiomas despite training, highlighting a need for clearer national guidelines.

## Contribution

The study reveals significant variability in IH management practices among Greek primary care physicians, emphasizing an implementation gap rather than a lack of knowledge.

## Key findings

- Physicians are more likely to intervene for head and neck IHs than for trunk or extremity lesions.
- Propranolol is widely used but often initiated late and with high inpatient preference.
- Structured tapering and post-treatment monitoring are rarely practiced.

## Abstract

Infantile hemangiomas (IHs) are the most common benign vascular tumors of infancy, and timely, risk-adapted management is critical to prevent functional and aesthetic complications. Although international evidence-based guidelines are well established, their implementation in everyday primary care practice remains inconsistent. We conducted a pragmatic, cross-sectional, web-based survey between November 2024 and February 2025 to characterize real-world management patterns of IHs among Greek primary care physicians who had completed a nationally accredited e-learning program on IH recognition and treatment. The survey comprised 10 multiple-choice items addressing treatment initiation criteria, pharmacologic strategies, monitoring and imaging practices, and treatment discontinuation. Seventy-four physicians participated, including 48 pediatricians (64.9%) and 26 general practitioners (GPs; 35.1%). Head and neck IHs larger than 2 cm prompted intervention in 40/48 pediatricians (83.3%) and 24/26 GPs (92.3%), compared with significantly lower intervention rates for similarly sized lesions on the trunk or extremities (30/48, 62.5% vs. 10/26, 38.5%; p = 0.048). Ulceration was infrequently recognized as an independent indication for systemic therapy (12/48 pediatricians, 25.0%; 4/26 GPs, 15.4%). Propranolol was widely adopted as first-line treatment; however, initiation most commonly occurred after 12 weeks of age (59/74 physicians, 79.7%), inpatient commencement was strongly favored even in low-risk cases (67/74, 90.5%), and dosing clustered around 2 mg/kg/day (71/74, 95.9%). Treatment discontinuation was typically abrupt (49/74, 66.2%), with structured tapering and post-treatment relapse surveillance infrequently reported. Despite shared theoretical training, substantial variability persists in the real-world management of IHs in Greek primary care, reflecting an implementation gap rather than a lack of knowledge. These findings highlight the need for context-sensitive national guidance emphasizing risk-adapted initiation and dosing, clearly defined imaging thresholds, safe outpatient pathways, and standardized follow-up to improve consistency and equity of care.