Steroids in Complicated Hemangioma
Subgroup: Volume 11, Issue 2
Date: April 2009
Type: Letter to Editor
Start Page: 217
End Page: 217
Keywords: Steroid; Complicated; Hemangioma
Haemangiomas are immature rests of vasofomative tissue that demonstrate angioblastic proliferation and regression, representing the most common vascular tumor of the childhood.1 Selecting the type of steroid, the course of administration, and the dose schedules will be guided by clinical experience.2 Intralesional injection of steroid is an effective treatment for hemangioma of the head and neck,3 with injection pressure exceeding the systemic arterial pressure routinely occur during intralesional injections steroid into capillary hemangiomas.4
In this study, 30 patients with complicated hemangioma of different age groups were enrolled. The cases were treated with local injection of 4 mg of triamcinolone diluted in 5 ml of normal saline in multiple sessions in a 2 week interval. The patients' age was from 3 months to 6 years, 20 being female and 10 male. The procedure was repeated every 2 weeks for 6-8 sessions depending on the severity of case, measuring the size of the lesion before each session to record its regression.
The most common age group suffering from hemangioma was that of females (20 patients). The age presentation to clinic was for 10 patients <1 year, for 10 patients from 1 year to <4 years, and for 10 patients from 4 years to <6 years. The most common sites of hemangioma in the patients were head and neck (51%), trunk (33%), extremities (13%), and the genitalia (3%). In 10 patients, the size of cutaneous hemangioma was 1x1 Cm; in 8 patients, it was 1x3 Cm; in 7 patients 2x4 Cm; and in 5 patients 3x5 Cm. After the treatment, 60% of cutaneous heamangiomas regressed in the age group of 1-<2 years old. Among 2-4 year old subjects, the regress was 40%, and in the age group >6 years old it was 25%. Three patients suffered from the complication of steroid treatment.
The age group of our patients was in accordance with what Winter et al. found that 65.3% of the cases were infants and children.3 Our female to male ratio was 2:1. Garzon reported 3 times more in females.1 The site of lesion agrees with Mullkin and Glowacki study finding that 60% of hemangiomas were in the head and neck area, 25% in the trunk, and 15% in the extremities.5 The majority of our cases were small in size, being in accordance with Garzon’s findings.6 After treatment with local steroid, the percentage of regression was similar to Akyus et al.’s findings that the age of initiation of treatment is the most important factor affecting the response to treatment.7
Conflict of interest: None declared.
- Garzon M. Hemangiomas: update on classification, clinical presentation, and associated anomalies. Cutis 2000; 66:325-8. 
- Mokni M, Phillips TJ. Management of pyoderma gangrenosum. Hosp Pract (Minneap) 2001;36:40-4. 
- Winter H, Dräger E, Sterry W. Sclerotherapy for treatment of hemangiomas. Dermatol Surg 2000;26:105-8. 
- Sadan N, Wolach B. Treatment of hemangiomas of infants with high doses of prednisone. J Pediatr 1996;128:141-6.  [doi:10.1016/S0022-3476(96)70446-8]
- Baker LL, Dillon WP, Hieshima GB, Dowd CF, Frieden IJ. Hemangiomas and vascular malformations of the head and neck: MR characterization. Am J Neuroradiol 1993;14:307-314.
- Boutros S. Hemangioma of the face. Perspective in plastic surgery, 2000; p. 45.