Efficacy of Oral Prednisolone Use in the Treatment of Infantile Hemangiomas in Indian Children

Abstract

Approximately 10% to 15% of patients with infantile hemangioma (IH) require treatment that needs to be individualized according to the size, location, and type of IH. Oral corticosteroids [CS] have been the mainstay of therapy, but dose and duration of therapy have been variably reported in literature. The possible side effects with high dose CS is a constant deterrant. Twenty infants with IH requiring therapy were treated with prednisolone at a dose of 3 to 4 mg/kg/day. Response to therapy, adverse effects, and risk of rebound growth were monitored. All of the treated lesions responded to prednisolone at 3.1 mg/kg/day given for a mean duration of 9.16 weeks by showing a cessation of active growth; 90% of patients showed partial to excellent response (Grade 2 to Grade 4 improvement). In the remaining 10% of patients there was <25% regression in the lesion. The total duration of therapy with tapering doses was 29.9 weeks. No cases of rebound growth were seen. The incidence of adverse effects was low, with one patient developing CS-induced hypertension (5%). Oral CS, given at appropriate doses, are a reasonably safe and highly efficacious treatment modality for IH. To prevent the risk of rebound growth, adequate prolongation of therapy is required.

Cutaneous vascular lesions and their management in Indian setting

“…have reported successful use of oral prednisolone at an average dose of 3.1 mg/kg/day given over a period of 9.16 weeks with more than 90% patients showing a good response to treatment. Rebound proliferation was seen in none of their patients , whereas Pandey et al. observed 80% response rate with oral prednisolone (1–2 mg/kg alternate day) .…”

Management of infantile hemangiomas: Current trends

“…Overall, 90% of the cases showed >25% improvement with no case of rebound phenomenon during their follow up period of 6 months to 1 year. [20]…”

Sclerotherapy for the treatment of infantile hemangiomas

“…However, inherent risks like Cushingoid features, hypertension, growth retardation, disturbance in the vaccination schedule and osteoporosis limit their use. [34] Propranolol is an important recent discovery, claimed to be useful in both proliferating and non-proliferating lesions. However, its use is also marred by significant and potentially life-threatening complications including hypoglycaemia, hyperkalaemia and cardiac sequelae.…”