title: Noninvasive management of hemangioma and vascular malformation using intralesional bleomycin injection.
abstract: BACKGROUND
  Successful treatment of vascular anomalies represents a challenging problem despite using various treatments. Intralesional injection of bleomycin has been successfully used in treatment of macrocystic lymphatic malformations and hemangiomas, based specifically on a high sclerosing effect on vascular endothelium.
  
  
  METHODS
  In a prospective study of 75 patients, there were 47 women and 28 men. Their ages ranged from 3 to 35 years with a mean age of 14 years. The effectiveness of intralesional bleomycin injection in hemangiomas and vascular malformations was evaluated.Dosage regimens used were as follows: - In children younger than 1 year, the maximum dose per injection is limited to 0.5 to 1 mg/kg and varied according to the size of the lesion. - In children older than 1 year and adult, a dose of 1 to 15 mg was injected intralesionally per session. A single dose of 15 mg per session was never exceeded. The interval between each session was 3 to 4 weeks.
  
  
  RESULTS
  Complete resolution (cured) in 18 (24%) patients, marked improvement occurred in 35 (47%) patients, mild improvement in 14 (18.5%) patients, and no cure in 8 (10.5%) cases. Local complications were superficial ulceration in 5 patients and hyperpigmentation in 6 patients. Systemic complications were flu-like symptoms in 3 patients. None of the patients presented with toxic hematological effects or signs of pulmonary fibrosis and/or hypertension.
  
  
  CONCLUSIONS
  Intralesional bleomycin injection is an effective and a safe method for treatment of hemangiomas and vascular malformations, decreasing the need for invasive primary surgery or systemic treatment in 71% of cases and decreasing the magnitude of secondary surgical procedures in cases with moderate results.
authors.affiliation: Plastic Surgery Department, Assiut University Hospital, Assiut, Egypt.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Hassan
authors.forename: Ahmed Kamal
authors.initials: AK
authors.lastname: Osman
authors.forename: AlMoutaz
authors.initials: A
authors.lastname: Altyeb
mesh_terms: D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D011446:Prospective Studies; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods*; D012878:Skin Neoplasms / Q000628:therapy*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000628:therapy*; D055815:Young Adult
chemical_list: D000903:Antibiotics, Antineoplastic; D012597:Sclerosing Solutions; D001761:Bleomycin