conservative treatment of cavernous hemangioma ... - Journal of IMAB

Figure 2: The procedure of intralesionalinjection of corticosteroidThe involution of tumor lesions started at the endof second year and at the end of third year theaesthetic result and regression were significant.(Figure 3)corticosteroids - have been proposed for treatinghemangioma, but the choice of treatment depend on acareful assessment of every case.[4,6,8]Corticosteroid therapy (intralesional application)has been proposed as the most efficient for cutaneoushemangioma, particularly for those involving the eyelids[2,3,5].Reported complications including occlusion of thecentral retinal artery, eyelid necrosis and optic nerveneuropathy are rare.[2]We injected Betamethasone (Celeston) into thecentral and satellite lesions every six months, for aperiod of four years. During this period no side effectswere observed.The therapy was initiated at the age of 3 months.After one year of treatment the size of the tumor wasunchanged, therefore the lesion would not regresswithout therapy.As it is difficult to predict accurately the durationof growth and the rate of spontaneous involution, thetreatment should be initiated as early as possible, andthe infant should be seen frequently.Figure 3: Result after two years of treatmentDISCUSSION:Hemangioma is a benign tumor in infancy. Thehallmark of this lesion is a rapid growth during theneonatal period. Most hemangiomas do not requiretreatment, as these resolve spontaneously. Batta et al.reported that among 121 infants with early hemangioma,about 40% cleared completely or left a minimal residualsign at the age of 1 year without treatment.Nevertheless, some complications or aesthetic concernsare indications for therapy. A number of treatmentmodalities – cryotherapy, radiation, laser therapy,Figure 4: Result after three years of treatmentThis case clearly demonstrates the positive resultsof using intralesional steroids. (Figure 4) Theophthalmic literature shows that local application isgenerally preferred over the oral route for eyelidlesions.[7]In conclusion, the best approach in managementof hemangioma should be individualized according to theage of patient, location, size of the lesion, and presenceof complications. Once the decision to treat hemangioma/ J of IMAB, 2007, vol. 13, book 1 / http://www.journal-imab-bg.org 41

is made, the main issues are the choice of the mostappropriate time and method of treatment. According tothe literature and our experience, the corticosteroidsremain the mainstay of therapy for massive eyelidhemangioma. In addition, early steroid therapy isassociated with better results. [8]REFERENCES:1. YC Chan,1MBBS, MRCP (UK),YCGiam,1MBBS, M Med (Paeds), FAMSGuidelines of Care for CutaneousHaemangiomas Ann Acad MedSingapore 2005;34:117-232. T M Ranchod, I J Frieden and DR Fredrick Corticosteroid treatment ofperiorbital haemangioma of infancy: areview of the evidence British Journalof Ophthalmology 2005;89:1134-1138;doi:10.1136/bjo.2005.0705083. Katarina G. Chiller, MD,MPH;Douglas Passaro, MD,MPH; Ilona J.Frieden, MD Hemangiomas of InfancyVol. 138 No. 12, December 2002D4. I. Vlachakis, S. Gardikis, E.Michailoudi, and G. CharissisTreatment of hemangiomas in childrenusing a Nd:YAG laser in conjunctionwith ice cooling of the epidermis:techniques and results BMC Pediatr.2003; 3: 25. Jiang Xue-wu, Wang Guanghuan,L. I. Jian-hong, Chen Zhong-xian,He Fei Expression of glucocorticoidreceptor isoforms in cutaneous hemangiomasand vascular malformationsChinese Medical Journal, 2005, Vol. 118No. 12 : 977-9816. Richard J Antaya, MD, InfantileHemangioma, www.emedicine.com7. Maria C. Garzon MD, Anne W.Lucky MD, Aimee Hawrot MD andIlona J. Frieden MD, Ultrapotenttopical corticosteroid treatment ofhemangiomas of infancy Journal of theAmerican Academy of DermatologyVolume 52, Issue 2 , February 2005,Pages 281-2868. Denise W. Metry, MD, Hemangiomasof infancy Morphology andlocation are clinical clues to potentialcomplications, WEB EXCLUSIVE /JULY 2003 / POSTGRADUATEMEDICINE9. L. A. Dourmishev and A. L. DourmishevCraniofacial cavernous hemangioma:succesful treatment withmethylprednisolone, Acta DermatovenAPA Vol 14, 2005, No 2Address for correspondence:D-r Snezhana MurgovaEye clinic, UMBAL Dr George Stranski - II-nd Clinical Base,91, Gen. Vladimir Vazov Str., 5800 Pleven, BulgariaPhone: +359/887 421 935E-mail: snejana_murgova@yahoo.com;42 http://www.journal-imab-bg.org / J of IMAB, 2007, vol. 13, book 1 /