Drug Therapy

“Drug therapy”:  Hemangioma size, growth pattern and location are important when a decision is made to use drug therapy. In general, steroid treatment should be considered only during the fast growth stage of the hemangioma. This treatment is generally not effective in later stages. The most commonly used drug is steroids (prednisone). A less commonly used agent is Interferon alfa-2a. 

Drug treatment is generally needed in:

  • Large facial hemangiomas (but may not be needed for scalp hemangiomas and deep hemangiomas in preauricular or cervical regions).

  • Hemangiomas in which a potential sequela can be difficult to correct surgically (facial lesions involving edge structures such as eyelid, lips, nares, columella, pinna).

  • Rapidly enlarging hemangiomas, especially if causing eyelid, ear, nose, lip dysfunction.

  • Hemangiomas involving the vital structures (ear canal, nares etc.).

  • Cyrano nose deformity.

  • Pedunculated facial hemangioma.

  • Genital-perineal-buttock hemangiomas. 

  • Hemangiomas in the digits.

Some physicians are more aggressive in terms of prescribing steroids for any deep hemangiomas in the proliferation phase and relatively superficial hemangiomas with a blue residuum after laser treatment.

The generally recommended steroid dosage (prednisone) ranges from 2 to 5 mg/kg/day. Some physicians recommend a high dosage to gain the full effect of steroids, and some physicians suggest a low dose in order to lower the potential side effects of steroids. Deeper hemangiomas may require a larger dose than that of superficial hemangiomas.

Some physicians begin tapering medication over several weeks or months when the tumor becomes dull and blanches, or it becomes soft, compressible and smaller. It is reported that steroids are effective in 87% patients. Some physicians suggest doubling the dosage if it is effective. Some physicians use a more regular steroid regimen, a 6 week course of therapy, using 2 mg/kg for 2 weeks, 1 mg/kg for 2 weeks, 0.5 mg/kg for 2 weeks. The patients should be monitored closely for any side effects and any immunization schedules should be adjusted accordingly.  

Some of the potential side effects of steroid use:

  • temporary slowing in physical growth
  • face swelling ("moon face")
  • behavioral changes (e.g., irritability, crying)
  • GI system ulcers
  • Increased appetite
  • increased risk of certain infections
  • high blood pressure

It should be noted that if the child is under 20 weeks old at the end of treatment, the lesion may start to enlarge again and in rare circumstances require further treatment.

If the steroid treatment is ineffective, interferon-alfa-2a may be given; however, it is very expensive and injection therapy is prolonged, averaging 8 months.  

Intratumoral steroid injection -  This method is used if systemic steroid treatment fails. If a decision is made to proceed with intratumoral steroid injection rather than a systemic use, Triamcinolone (25 mg/ml) is injected slowly using a 3 ml syringe and 25 g needle (maximum 3-5 mg/kg/procedure). Usually 3 to 5 injections are needed at 6-8 weeks intervals. Similar results to systemic steroid use can be obtained.





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