Diagnosis and Management of Infantile Hemangioma

Table 5. Key resolution outcomes in studies comparing intravenous or intralesional and oral
corticosteroids
Author, Year
Comparison
Groups (n)
Quality
Age
Type
Location
Measures of
Resolution/
Response
Resolution
Outcomes
Rebound Growth/
Recurrence, n (%)
Other Outcomes
Pope et al.
2007 107
G1: Methylprednisolone,
30 mg/kg
infused over
an hour for
three days
monthly (10)
G2:
Prednisolone,
oral
2/mg/kg/day
(10)
Quality:
Good
Jalil et al.
2006 108
G1:
Triamcinolone
1-5 mg/kg
intra-lesional
(25)
G2:
Prednisolone,
oral 2/mg/kg/
on alternate
days (25)
G3:
Observation
(25)
Quality: Poor
Age,
mean±SD,
weeks
G1: 12 ± 3
G2: 11 ± 4
Type
All children
had mixed,
superficial
and deep
facial IH
Age,
mean±SD,
months
(range)
G1+G2+G3:
5.0 ± 2.9
(1 to 12)
Type
Superficial,
%
G1+G2+G3:
73.3
Deep
G1+G2+G3:
6.6
Combined
G1+G2+G3:
20
G1+G2:
Multiple
G1+G2+
G3:
Multiple
• 100-mm visual
analog scale
(0:no change,
+:decrease in
size,
-:increase in
size)
• Blinded
assessors
• Grade I greater
than 50%
reduction in size
• Grade II less
than 50%
reduction in size
• Grade III little or
no decrease (or
increase)
• Blinded
assessment: NR
VAS score at 3
months, median
(IQR)
G1: 12 (-18 to 39)
G2: 70 (54 to 80)
G1 vs. G2 p=0.002
VAS score at 1
year, median (IQR)
G1: -1.5 (-35 to 22)
G2: 50 (35 to 67)
G1 vs. G2 p=0.005
Lesion size
reduction
Grade I
G1: 11
G2: 8
G3: 0
Grade II
G1: 8
G2: 11
G3: 1
Grade III
G1: 6
G2: 6
G3: 19
No change
G3: 5
Need for additional
treatment, n (%)
G1: 7 (54)
G2: 6 (46, additional
treatment given for
regrowth specifically)
Vision outcomes
• Eye involvement in 5
children in G1 and 3
in G2
• No change in eye
findings in 1 child in
each group at 1 year,
and improvement in 4
in G1 and 2 in G2
Rebound growth
G1: 0
G2: 1
G3: 0
G = group; IH = infantile hemangioma; IQR = interquartile range; kg = kilogram; mm = millimeter; mg= milligram; n = number;
SD = standard deviation; VAS = visual analog scale
Intralesional Versus Topical Steroids
One fair quality RCT conducted in India randomized children (age range=NR) with less than
or equal to two superficial IH of less than 5 cm to daily topical mometasone furoate (n=52) or
monthly intralesional triamcinolone (n=47) for 6 to 8 months (Table 6). 122 Patients in this study
likely overlap with those described in a retrospective case series, 120 but the extent of overlap is
not clear. Forty-five children in each group responded to treatment (mometasone: 50% excellent,
36.5% good, 13.4% poor response; triamcinolone: 63.8% excellent, 31.9% good, 4.2% poor
response). Response to steroids did not differ by age or sex.
27