Steroid therapy for problematic proliferating haemangioma

To evaluate the effectiveness and the safety of systemic and intralesional steroid therapy for problematic proliferating haemangioma.

233 patients with haemangioma were identified from our vascular anomalies database 1996-2007. 46 (36%) out of 129 patients with proliferating haemangioma required intervention. 24 of these patients received steroid therapy. Indications for steroid therapy, the response and side effects of treatment and the need for other treatment were recorded. Intralesional triamcinolone up to 4 mg/kg/injection was preferred for small, localised non-periorbital lesions in 5 patients and oral prednisolone 2.0-2.5 mg/kg/day was used for larger lesions, especially around the periorbital region in 19 patients.

Accelerated regression of the haemangioma was observed in four of the five patients who received intralesional triamcinolone and there was no complication. Overall, the haemangioma in 17 (89%) of the 19 patients responded to high dose oral prednisolone with accelerated regression noted in 10 (53%) patients. Rebound growth was observed in 5 patients during dose tapering, requiring dose increment in three patients and debulking surgery in one patient. Three patients developed growth retardation during treatment but this normalised 3-10 months following cessation of steroid therapy. Other side effects included mild Cushingoid features (n=2), irritability (n=2), increased appetite (n=3).

Intralesional and systemic steroid are relatively safe and effective in treating problematic proliferating haemangioma. Systemic steroid therapy is associated with few short-term side effects. A multidisciplinary management is essential. Propranolol is likely to replace steroid as the first-line treatment for problematic proliferating haemangioma.