ment . ▁ ▁Lar ge ▁I H s ▁can ▁leave ▁visible ▁skin ▁changes ▁secondary ▁to ▁significant ▁stretch ing ▁of ▁the ▁skin ▁or ▁alter ation ▁of ▁surface ▁texture . ▁When ▁they ▁inter f ere ▁with ▁vision , ▁breath ing , ▁or ▁threaten ▁significant ▁dis figure ment ▁( most ▁not ably ▁fa cial ▁les ions , ▁and ▁in ▁particular , ▁nose ▁and ▁lips ), ▁they ▁are ▁usually ▁treated . ▁ ▁Medical ▁ther ap ies ▁are ▁most ▁effective ▁when ▁used ▁during ▁the ▁period ▁of ▁most ▁significant ▁hem ang i oma ▁growth , ▁which ▁corresponds ▁to ▁the ▁first ▁ 5 ▁months ▁of ▁life . ▁ ▁Ul cer ated ▁hem ang iom as , ▁a ▁subset ▁of ▁les ions ▁requiring ▁ther apy , ▁are ▁usually ▁treated ▁by ▁address ing ▁w ound ▁care , ▁pain , ▁and ▁hem ang i oma ▁growth . ▁ ▁Medic ation ▁Tre at ment ▁options ▁for ▁I H s ▁include ▁medical ▁ther ap ies ▁( system ic , ▁intr ales ional , ▁and ▁top ical ), ▁surg ery , ▁and ▁las er ▁ther apy . ▁ ▁Prior ▁to ▁ 2 0 0 8 , ▁the ▁main st ay ▁of ▁ther apy ▁for ▁problem atic ▁hem ang iom as ▁was ▁or al ▁cort ic ost ero ids , ▁which ▁are ▁effective ▁and ▁remain ▁an ▁option ▁for ▁patients ▁in ▁whom ▁beta - block er ▁ther apy ▁is ▁contra ind ic ated ▁or ▁poor ly ▁toler ated . ▁ ▁Following ▁the ▁ser end ip it ous ▁observation ▁that ▁pro pr an ol ol , ▁a ▁non select