1. Home>
2. Specialties>
3. Dermatology>
4. Summary and Comment

Hemangiomas: Prednisone Proves Promising

Hemangiomas occur in 10 percent of infants. A substantial number of affected infants require treatment, but a gold standard therapy has not been defined. To determine the efficacy, optimal dosing, and safety of systemic corticosteroid therapy for problematic cutaneous hemangiomas, investigators from the University of California-San Francisco conducted a meta-analysis of studies identified by systematic literature review. PubMed and Medline searches for "hemangiomas and corticosteroids" produced 200 references in 7 languages. Careful review yielded 10 original case series involving a minimum of 5 patients treated with corticosteroids (184 patients in all).

Patients began treatment at a mean age of 4.5 months, with a mean prednisone-equivalent dosage of 2.9 mg/kg/day given over a mean of 1.8 months before tapering, if applicable. The mean response rate was 84 percent, and the mean rebound rate was 36 percent. The mean prednisone-equivalent dosage in responders was 3.0 mg/kg, and the mean dosage in nonresponders was 2.1 mg/kg, a significant difference. There was no difference between responders and nonresponders in duration of treatment. Infants treated with <2 mg/kg daily had a higher rate of rebound growth, and those who received >3 mg/kg daily had more adverse effects. Adverse events occurred in 51 percent of infants who received the highest doses but in only 4 percent of those who received the lowest doses. Several studies failed to monitor for such occult adverse effects as hypothalamic-pituitary-adrenal axis suppression and hypertension.

Comment: This evidence-based analysis supports the use of systemic corticosteroids for problematic infantile hemangiomas in the first 4 months of life. It suggests that a prednisone-equivalent dosage of 2 to 3 mg/kg/day will maximize response and minimize side effects. Additional studies are needed to establish the optimal timing and duration of therapy and guidelines for monitoring adverse effects.

— EC Siegfried

Published in Journal Watch Dermatology November 21, 2001

Citation(s):

Bennett ML et al. Oral corticosteroid use is effective for cutaneous hemangiomas: an evidence-based evaluation. Arch Dermatol 2001 Sep 137 1208-1213.

• Original article (Subscription may be required)
• Medline abstract (Free)