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Infantile Hemangioma: Treatment with Short Course Systemic Corticosteroid Therapy as an Alternative for Propranolol

Authors

  • Klaske Nieuwenhuis M.D.,

    1. Department of Pediatrics
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  • Peter C. J. de Laat M.D., Ph.D.,

    1. Department of Pediatrics
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    • Working Group on Vascular Anomalies Rotterdam team.

  • Sherief R. Janmohamed M.D.,

    1. Division of Pediatric Dermatology, Sophia Children’s Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
    2. Kinderhaven, Havenziekenhuis, Rotterdam, The Netherlands
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  • Gerard C. Madern M.D.,

    1. Department of Pediatric Surgery, Sophia Children’s Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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    • Working Group on Vascular Anomalies Rotterdam team.

  • Arnold P. Oranje M.D., Ph.D.

    1. Division of Pediatric Dermatology, Sophia Children’s Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
    2. Kinderhaven, Havenziekenhuis, Rotterdam, The Netherlands
    3. Department of Dermatology, Maasstadziekenhuis, Rotterdam, The Netherlands
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    • Working Group on Vascular Anomalies Rotterdam team.


Address correspondence to Peter C. J. de Laat, M.D., Ph.D., Room Sk 2214, Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC, University Medical Center, 3015 GJ Rotterdam, The Netherlands, or e-mail: p.c.j.delaat@erasmusmc.nl.

Abstract

Abstract:  Infantile hemangiomas (IHs) are increasingly being treated with propranolol or other beta-blockers, but before this therapeutic option was available, oral glucocorticosteroids (GCSs) were the criterion standard treatment and are still the alternative modality in problematic cases. Nevertheless, there is no standard treatment protocol for the dose and duration of GCSs. Long-term treatment with GCSs is associated with unwanted side effects such as growth suppression, behavioral changes, and reflux. Twenty-one children with troublesome IHs were treated according to an algorithm with 3 mg/kg/day of oral prednisolone divided three times per day with varying duration and number of GCS courses. Two blinded investigators independently interpreted therapy results using the Hemangioma Activity Score (HAS). Side effects were determined according to reports in patient charts and parental questionnaires. The median duration of a short course of GCSs was 2 weeks (range 1–6 weeks). The number of courses was 2 (range 1–5). The median cumulative dose was 91 mg/kg. Growth stabilized in all patients, with a good response (>50% reduction in HAS) in 62% and a favorable response (30–50% reduction is HAS) in 23%. Twelve of the 21 children (57%) had minor side effects. Persistent side effects did not occur. Intermittent short course, systemic, high-dose GCS therapy is an effective and safe treatment modality for IH, with a substantially lower cumulative dose of GCSs compared to prolonged therapy and no major side effects. This treatment is an alternative in cases in which propranolol fails or is contraindicated.

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