Diagnosis and Management of Infantile Hemangioma

of the model fit to all studies, but with much wider posterior credible intervals. Since there was
no obvious systematic bias due to study design, we reported the model estimates based on the
entire body of evidence.
Figure 6. Estimates of the variation of each treatment
Note: Estimates of the variation of each treatment are expressed as standard deviation, along with associated posterior
interquartile range (thick lines) and 95% credible interval (thin lines).
Effectiveness and Harms of Corticosteroids
Key Points
• In our network meta-analysis, oral steroids had a clearance rate of 43 percent (95%
Bayesian credible interval [BCI]: 21% to 66%), and the rate for intralesional
triamcinolone was 58 percent (95% BCI: 22% to 93%) compared with 6 percent (95%
BCI: 1% to 11%) for placebo or observation (moderate SOE for improvement in IH with
oral steroids vs. observation or placebo; low SOE for greater effectiveness of
intralesional steroids vs. observation or placebo). This means that we would expect to
see, on average, 43 percent clearance of IH in children receiving oral steroids relative to 6
percent with placebo or no treatment.
• Steroids studied varied in dose, type, and route of administration.
• Children in treatment arms typically experienced reductions in lesion size, but outcomes
across studies are difficult to compare given differences in scales.
• Harms were varied and frequently included Cushingoid facies, irritability/mood changes,
growth retardation, and skin atrophy or depigmentation. Ulceration was frequently
reported in studies of intralesional steroids. SOE was moderate for the association of
steroids with clinically important harms.
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