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[Intralesional corticosteroid therapy in infantile hemangiomas]
Elzbieta Gawrych1, Anna Walecka, Justyna Rajewska
1Klinika Chirurgii Dzieciecej i Onkologicznej Pomorskiej Akademii Medycznej w Szczecinie ul. Unii Lubelskiej 1, 71-252 Szczecin.
Introduction:
This study was undertaken to evaluate the effectiveness of intralesional corticosteroid therapy in infantile hemangiomas.
Material And Methods:
The study was done in 38 patients aged 1 month to 14 years with infants accounting for 84% of all patients. Physical investigation was carried out before and after treatment. Localization, size of tumor, pressure, and surface features were recorded. Doppler ultrasound was performed concomitantly and served to measure tumor size and blood flow in tumor vasculature. Midazolanium 1-2 mg/kg was administered intravenously without general anesthesia. Treatment consisted of 3-5 doses of Polcortolon with intervals of 5-6 weeks between doses. The corticosteroid dose was individualized and depended on tumor size and age of patient. The results were analyzed with the modified Sloan's scale.
Results:
Hemangioma was disclosed immediately after birth in 30 patients (78%). The tumor had an intense cherry color and demonstrated increased pressure and fast enlargement during the first weeks of life. In the remaining eight patients (22%), the tumor appeared after the second month of life and failed to show features of fast growth during the first year of life. The location of hemangioma was on the head and neck in 22 children (58%) and on the chest, extremities, abdomen, or lower back (lumbar region) in the remaining children. Doppler ultrasound revealed increased vascular flow in the tumor of all patients. Intralesional corticosteroid therapy resulted in reduction of tumor volume of more than 50% in 18 (47%), less than 50% in 12 (32%), and little or no change in eight (21%) cases. A very good result in one patient was achieved with two weeks of supplemental oral Prednisolon therapy. Total or partial excision of the tumor for aesthetic reasons was done in eight patients in whom intralesional corticosteroid therapy produced substantial reduction in tumor size.
Conclusions:
Intralesional corticosteroid therapy is an effective and safe modality particularly suitable for the management of extensive hemangiomas of the head and neck when surgical options are limited.
