Oral versus high-dose pulse corticosteroids for problematic infantile hemangiomas: a randomized, controlled trial

Area of Science:

• Pediatric dermatology
• Vascular anomalies
• Pharmacology

Background:

• Systemic corticosteroids are standard treatment for problematic infantile hemangiomas.
• Current evidence relies on anecdotal data and retrospective studies.
• Efficacy and safety of different corticosteroid regimens require further investigation.

Purpose of the Study:

• To evaluate the efficacy of systemic corticosteroids in proliferating infantile hemangiomas.
• To compare the efficacy and safety of daily oral prednisolone versus monthly intravenous methylprednisolone pulses.

Main Methods:

• A randomized trial involving 20 infants with problematic hemangiomas.
• Comparison of clinical outcomes (Visual Analog Scale) and adverse events at 3 months and 1 year.
• Analysis of angiogenesis surrogate markers for the first 3 months.

Main Results:

• Oral prednisolone demonstrated superior clinical improvement compared to intravenous pulses at 3 months and 1 year.
• Angiogenesis markers (VCAM-1, endoglin) decreased with treatment.
• Oral corticosteroid group experienced higher rates of adverse effects, including hypertension and growth retardation.

Conclusions:

• Systemic corticosteroids are effective in halting hemangioma proliferation.
• Daily oral prednisolone offers greater clinical and biological benefits than pulse therapy.
• Increased adverse events necessitate careful monitoring with oral corticosteroid treatment.