Arin K Greene1, Rafael A Couto. 1. Boston, Mass. From the Department of Plastic and Oral Surgery, Children's Hospital Boston, Harvard Medical School.
Abstract
BACKGROUND: The efficacy of oral corticosteroid therapy for problematic infantile hemangioma depends on dosage, duration of treatment, and definition of therapeutic response. The purpose of this study was to determine the efficacy and safety of oral corticosteroid therapy using a standardized treatment protocol. METHODS: The study comprised 25 consecutive patients with infantile hemangioma managed with oral prednisolone between 2007 and 2010. All patients were given 3 mg/kg/day for 1 month, followed by a 0.5-ml taper every 2 to 4 weeks. Predictive variables were age at initiation of treatment, sex, location, lesion size, and tumor depth. Treatment response was defined as no response, stabilization, or regression. Rebound growth and drug morbidity were recorded. RESULTS: Tumors primarily affected the cheek (n = 12), orbit (n = 8), nose (n = 2), forehead (n = 2), or neck (n = 1). Treatment was initiated at an average age of 12.1 ± 7.2 weeks for 32.2 ± 10.0 weeks. All tumors responded to therapy; 88.0 percent (n = 22) regressed and 12.0 percent (n = 3) stabilized. Age at initiation of treatment, sex, location, lesion size, and tumor depth did not affect treatment response (p = 0.13). Rebound growth occurred in 8.0 percent of infants, and 20.0 percent demonstrated a transient cushingoid appearance. No patients suffered drug morbidity. CONCLUSIONS: The administration of oral prednisolone using a standardized protocol of 3 mg/kg given once daily for 1 month, followed by a taper until the infant is 10 months of age, is an effective treatment for infantile hemangioma. Therapy is safe because it is limited to several months and the dosage is continually weaned as the infant gains weight. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
BACKGROUND: The efficacy of oral corticosteroid therapy for problematic infantile hemangioma depends on dosage, duration of treatment, and definition of therapeutic response. The purpose of this study was to determine the efficacy and safety of oral corticosteroid therapy using a standardized treatment protocol. METHODS: The study comprised 25 consecutive patients with infantile hemangioma managed with oral prednisolone between 2007 and 2010. All patients were given 3 mg/kg/day for 1 month, followed by a 0.5-ml taper every 2 to 4 weeks. Predictive variables were age at initiation of treatment, sex, location, lesion size, and tumor depth. Treatment response was defined as no response, stabilization, or regression. Rebound growth and drug morbidity were recorded. RESULTS:Tumors primarily affected the cheek (n = 12), orbit (n = 8), nose (n = 2), forehead (n = 2), or neck (n = 1). Treatment was initiated at an average age of 12.1 ± 7.2 weeks for 32.2 ± 10.0 weeks. All tumors responded to therapy; 88.0 percent (n = 22) regressed and 12.0 percent (n = 3) stabilized. Age at initiation of treatment, sex, location, lesion size, and tumor depth did not affect treatment response (p = 0.13). Rebound growth occurred in 8.0 percent of infants, and 20.0 percent demonstrated a transient cushingoid appearance. No patients suffered drug morbidity. CONCLUSIONS: The administration of oral prednisolone using a standardized protocol of 3 mg/kg given once daily for 1 month, followed by a taper until the infant is 10 months of age, is an effective treatment for infantile hemangioma. Therapy is safe because it is limited to several months and the dosage is continually weaned as the infant gains weight. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.