Corticosteroids therapy in the management of infantile cutaneous hemangiomas.
OBJECTIVE
To determine the effectiveness of systemic and intra-lesional corticosteroids, in the management of infantile cutaneous hemangiomas and to compare the results with untreated lesions.


METHODS
Randomized controlled trial.


METHODS
Surgical Unit B of National Institute of Child Health, Karachi, from January 2001 to January 2003.


METHODS
A total of 75 cases with cutaneous hemangiomas were included in the study. Three groups of 25 patients each were made by allocating first patient to control group, every second patient to oral steroid group and every third patient to intra-lesional steroid group. In control group, patients were managed conservatively with repeated hospital visits in order to note down changes occurring in the lesion. In oral steroid group, tablet prednisolone was given at a dose of 2mg/kg/day on alternate days. The dose was gradually tapered over a period of 8 weeks. In intra-lesional steroid group, injection triamcinolone was given at a dose of 1 to 5 mg/kg, with a maximum dose of 30mg. Six injections of triamcinolone in monthly intervals were given. Outcome measures noted were the change in size before and after treatment, duration of proliferative phase, change in morphology and complications.


RESULTS
In the control group,76% lesions showed little or no change, 5.8% had less than 50% reduction and 20% lesions showed actual increase in size. In oral steroid group, 32% lesions showed greater than 50% reduction in size, 44% lesions had less than 50% reduction and 24% lesions had little or no change. In intra-lesional steroid group, 44% lesions showed greater than 50% reduction in size, 32% lesions showed less than 50% reduction and 24% lesions had little or no change. Morphology change in terms of color change, surface bosselation and soft consistency was found in 88% lesions of oral steroid group, 92% in intra-lesional steroid group and 16% in observation group. Complication rate was 16% in observation group, 20% in oral steroid group and 24% in intra-lesional steroid group.


CONCLUSIONS
Hemangiomas when left untreated behave in an unpredictable manner. Low dose steroids whether given orally or intra-lesionally, showed remarkable reduction in size with minimal side effects.
Jalil
Shazia
S
Department of Paediatric Surgical Unit B, National Institute of Child Health, Karachi.
Akhtar
Jamshed
J
Ahmed
Soofia
S
D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D012878:Skin Neoplasms / Q000188:drug therapy*; D014221:Triamcinolone / Q000008:administration & dosage
D005938:Glucocorticoids; D014221:Triamcinolone