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Management of problematic infantile hemangioma using intralesional triamcinolone: efficacy and safety in 100 infants.
J Plast Reconstr Aesthet Surg 2014; 67(11):1469-74JP

Abstract

BACKGROUND

Intralesional corticosteroid is one method used to limit the rapid growth of infantile hemangiomas. The purpose of this study was to determine the efficacy and safety of triamcinolone injection using a standardized protocol.

METHODS

The study comprised infants managed with intralesional corticosteroid between 2007 and 2013. Tumors ≤3 cm in diameter were injected with triamcinolone, not to exceed 3 mg/kg, and followed every 4-6 weeks to determine whether additional injections were indicated. Predictive variables were patient age and tumor location, depth, and size. Treatment response was defined as regression, stabilization, or failure. Rebound growth and drug morbidity were recorded.

RESULTS

Seventy-three females and 27 males had lesions located on the lip (29%), cheek (20%), nose (16%), periorbital area (13%), forehead (7%), scalp (4%), chin (2%), ear (2%), trunk (2%), extremity (2%), and neck (2%). Mean tumor size was 2.1 cm(2) (range 0.15-9.0). Treatment began at an average age of 11 weeks (range 3-30). The mean number of injections was 1.8 (range 1-5), and the average dose per injection was 1.6 mg/kg (range 0.76-2.66). All tumors responded: 63% regressed and 37% stabilized. Rebound growth affected 40% of tumors at a median of 3 weeks (IQR 3-4) following injection. Age, location, size, and depth did not affect treatment response (p = 0.7). None of the patients exhibited systemic side-effects and 2% had atrophy at the site of injection.

CONCLUSION

Intralesional triamcinolone is an effective treatment for small, localized proliferating infantile hemangiomas. Therapy is safe and infants are at minimal risk for systemic side-effects when low doses of corticosteroid are used.

Authors+Show Affiliations

Department of Plastic and Oral Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.Department of Plastic and Oral Surgery, Vascular Anomalies Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: arin.greene@childrens.harvard.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25104131

Citation

Couto, Javier A., and Arin K. Greene. "Management of Problematic Infantile Hemangioma Using Intralesional Triamcinolone: Efficacy and Safety in 100 Infants." Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, vol. 67, no. 11, 2014, pp. 1469-74.
Couto JA, Greene AK. Management of problematic infantile hemangioma using intralesional triamcinolone: efficacy and safety in 100 infants. J Plast Reconstr Aesthet Surg. 2014;67(11):1469-74.
Couto, J. A., & Greene, A. K. (2014). Management of problematic infantile hemangioma using intralesional triamcinolone: efficacy and safety in 100 infants. Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS, 67(11), pp. 1469-74. doi:10.1016/j.bjps.2014.07.009.
Couto JA, Greene AK. Management of Problematic Infantile Hemangioma Using Intralesional Triamcinolone: Efficacy and Safety in 100 Infants. J Plast Reconstr Aesthet Surg. 2014;67(11):1469-74. PubMed PMID: 25104131.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of problematic infantile hemangioma using intralesional triamcinolone: efficacy and safety in 100 infants. AU - Couto,Javier A, AU - Greene,Arin K, Y1 - 2014/07/15/ PY - 2013/11/01/received PY - 2014/03/15/revised PY - 2014/07/06/accepted PY - 2014/8/9/entrez PY - 2014/8/12/pubmed PY - 2015/2/18/medline KW - Efficacy KW - Hemangioma KW - Injection KW - Protocol KW - Safety KW - Steroid SP - 1469 EP - 74 JF - Journal of plastic, reconstructive & aesthetic surgery : JPRAS JO - J Plast Reconstr Aesthet Surg VL - 67 IS - 11 N2 - BACKGROUND: Intralesional corticosteroid is one method used to limit the rapid growth of infantile hemangiomas. The purpose of this study was to determine the efficacy and safety of triamcinolone injection using a standardized protocol. METHODS: The study comprised infants managed with intralesional corticosteroid between 2007 and 2013. Tumors ≤3 cm in diameter were injected with triamcinolone, not to exceed 3 mg/kg, and followed every 4-6 weeks to determine whether additional injections were indicated. Predictive variables were patient age and tumor location, depth, and size. Treatment response was defined as regression, stabilization, or failure. Rebound growth and drug morbidity were recorded. RESULTS: Seventy-three females and 27 males had lesions located on the lip (29%), cheek (20%), nose (16%), periorbital area (13%), forehead (7%), scalp (4%), chin (2%), ear (2%), trunk (2%), extremity (2%), and neck (2%). Mean tumor size was 2.1 cm(2) (range 0.15-9.0). Treatment began at an average age of 11 weeks (range 3-30). The mean number of injections was 1.8 (range 1-5), and the average dose per injection was 1.6 mg/kg (range 0.76-2.66). All tumors responded: 63% regressed and 37% stabilized. Rebound growth affected 40% of tumors at a median of 3 weeks (IQR 3-4) following injection. Age, location, size, and depth did not affect treatment response (p = 0.7). None of the patients exhibited systemic side-effects and 2% had atrophy at the site of injection. CONCLUSION: Intralesional triamcinolone is an effective treatment for small, localized proliferating infantile hemangiomas. Therapy is safe and infants are at minimal risk for systemic side-effects when low doses of corticosteroid are used. SN - 1878-0539 UR - https://www.unboundmedicine.com/medline/citation/25104131/Management_of_problematic_infantile_hemangioma_using_intralesional_triamcinolone:_efficacy_and_safety_in_100_infants_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1748-6815(14)00356-8 DB - PRIME DP - Unbound Medicine ER -