Fatma DEMİREL, Bahattin TUNÇ, Suna EMİR, Dilek GÖKÇEBAY GÜRLEK

Efcacy and safety of intralesional corticosteroid application for hemangiomas

Background/aim: Tere are diferent modalities for management of infantile hemangiomas (IHs). In this report, our aim is to evaluatewhether intralesional corticosteroid treatment is associated with systemic side efects and whether this is an efective treatment modalityfor IH.Materials and methods: Six children treated with intralesional corticosteroids for problematic hemangiomas were included in thestudy. Clinical characteristics, response to treatment, weight, height, blood pressure, morning serum cortisol, and adrenocorticotropichormone levels were recorded.Results: Each child received intralesional triamcinolone at a dose of 2 mg/kg for 2 5 injections at monthly intervals. Subjectswere followed for 1 year. All patients had adrenal suppression following the second or third triamcinolone injections. Five patientsdemonstrated partial response and one demonstrated no response. Conclusion: Intralesional steroid injection may efectively induce the resolution of hemangiomas, but all the patients in our group hadadrenal suppression afer treatment. Te use of intralesional steroid therapy is not a superior treatment option for hemangiomas. It alsohas side efects comparable to systemic steroids.

PDF

___

1. Chiller KG, Passoro D, Frieden IJ. Hemangiomas of infancy. Arch Dermatol 2002;138: 15671576.
2. Bruckner AL, Frieden IJ. Hemangiomas in infancy. J Am Acad Dermatol 2003; 48: 477493.
3. Serra AMS, Soares FMG, Cunha Jr AG,Costa IMC. Terapeutic management of skin hemangiomas in children. An Bras Dermatol 2010; 85: 307317.
4. Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Tambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008; 358: 26492651.
5. Lawley LP, Siegfried MD, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol 2009; 26: 610614.
6. Pavlakovic H, Kietz S, Laurer P, Zutt M, Lakomek M. Hyperkalemia complicating propranolol treatment of an infantile hemangioma. Pediatrics 2010; 126: 15891593.
7. Awadein A, Fakhry MA. Evaluation of intralesional propranolol for periocular capillary hemangioma. Clin Ophtalmol 2011; 5: 11351140.
8. Zimmermann AP, Wiegand S, Werner JA, Eivazi B. Propranolol therapy for infantile hemangiomas: review of the literature. Int J Pediatr Otorhinolaryngol 2010; 74: 338342.
9. Lv MM, Fan XD, Su LX. Propranolol for problematic head and neck hemangiomas: an analysis of 37 consecutive patients. Int J Pediatr Otorhinolaryngol 2012; 76: 574578.
10. Chung SH, Park DH, Jung HL, Shim JW, Kim DS, Shim JY, Park MS, Koo HH. Successful and safe treatment of hemangioma with oral propranolol in a single institution. Korean J Pediatr 2012; 55: 164170.
11. Gunturi N, Ramgopal S, Balagopal S, Scott JX. Propranolol therapy for infantile hemangioma. Indian Pediatr 2013; 50: 307313.
12. Xiao Q, Li Q, Zhang B, Yu W. Propranolol therapy of infantile hemangiomas: efcacy, adverse efects, and recurrence. Pediatr Surg Int 2013; 29: 575581.
13. Caussé S, Aubert H, Saint-Jean M, Puzenat E, Bursztejn AC, Eschard C, Mahé E, Maruani A, Mazereeuw-Hautier J, Dreyfus I et al. Propranolol-resistant infantile hemangiomas. Br J Dermatol 2013; 169: 125129.
14. Janmohamed SR, Madern GC, Nieuwenhuis K, deLaat PC, Oranje AP. Evaluation of intra-lesional corticosteroids in the treatment of peri-ocular haemangioma of infancy: still an alternative besides propranolol. Pediatr Surg Int 2012; 28: 393 398.
15. Kushner BJ. Intralesional corticosteroid injection for infantile adnexial hemangioma. Am J Ophtalmol 1982; 93: 496506.
16. Gangopadhyay AN, Sharma SP, Gopal SC, Gupta DK, Panjawani K, Sinha JK. Local steroid therapy in cutaneous hemangiomas. Indian Pediatr 1996; 33: 3133.
17. Prasetyono TO, Djoenaedi I. Efcacy of intralesional steroid injection in head and neck hemangioma: a systematic review. Ann Plast Surg 2011; 66: 98106.
18. Chantharatanapiboon W. Intralesional corticosteroid therapy in hemangiomas: clinical outcome in 160 cases. J Med Assoc Tai 2008; 91: 9096.
19. Wasserman BN, Medow NB, Homa-Palladino M, Hoehn ME. Treatment of periocular hemangiomas. J AAPOS 2004; 8: 175 181.
20. Morkane C, Gregory JW, Watts P, Warner JT. Adrenal suppression following intralesional corticosteroids for periocular haemangiomas. Arch Dis Child 2011; 96: 587589.
21. Goyal R, Watts P, Lane CM, Beck L, Gregory JW. Adrenal suppression and failure to thrive afer steroid injections for periocular hemangioma. Ophthalmology 2004; 111: 389395.