Diagnosis and Management of Infantile Hemangioma

children in 8 studies), skin atrophy (0.95%-17% of children in five studies), hypopigmentation
(1.4% to 16% of children in 6 studies), hypertension (0.11% to 5% of children in five studies),
infection (2% to 15% of children in 5 studies), and behavioral changes (25% to 100% of children
in four studies). Cushingoid appearance and growth retardation occurred regardless of dosage
form (i.e., intralesional, oral).
One study reported on several “ultrapotent” topical steroids (betamethasone dipropionate,
clobetasol propionate, halobetasol propionate, 0.05%) in children with primarily superficial IH
and noted that 2 of 34 children (agents received not specified) experienced hypopigmentation. 127
Another reporting on several corticosteroids including oral prednisolone, clobetasol propionate,
and intralesional triamcinolone plus betamethasone in 30 children with complicated IH reported
adverse effects in the aggregate rather than by agent. 129 Most children received prednisolone, and
harms included decreased rate of linear growth (n=14), decreased weight gain (n=9), Cushingoid
facies (n=7), increased weight gain (n=5), decreased head growth (n=4), hirsutism (n=4), delayed
motor milestones (n=3), thrush (n=3), premature thelarche (n=2), increased rate of linear growth
(n=1), sterid acne (n=1), gastritis (n=1), and varicella infection (n=1). 129 Three case series
evaluating intralesional steroids reported that no adverse events occurred, 123,126,128 and none
explicitly reported discontinuation of treatment due to adverse events.
Table 9. Adverse effects in case series of steroids to treat IH
Intervention
Intralesional
triamcinolone+betamethasone †
Intralesional
triamcinolone+dexamethasone
Intralesional
triamcinolone+prednisolone
Harm/Adverse Event
Number Of
Studies
(# Participants
With Harm/Total
Participants)
Reported Rates
Across Studies
Cushingoid appearance 110,112 2 (5/100) 3%-10%
Hypopigmentation 110 1 (2/70) 3%
Periocular calcification 121 1 (1/34) 3%
Abscess at injection site 111 1 (1/27) 4%
Subcutaneous fat atrophy 111 1 (1/27) 4%
Ulceration 120 1 (130/628) 21%
Skin atrophy 120 1 (106/628) 17%
Hypopigmentation 120 1 (101/628) 16%
Infection 120 1 (91/628) 14%
Cushingoid appearance 120 1 (37/628) 6%
Growth retardation 120 1 (37/628) 6%
Hypertension 120 1 (30/628) 5%
Intralesional triamcinolone ** Ulceration 114,120 2 (150/1046) 4%-16%
Infection 109,120 2 (105/991) 2%-12%
Anaphylactic shock 115 1 (3/155) 2%
Hypopigmentation 114,120 2 (93/1046) 1%-10%
Peptic ulcer 114 1 (2/160) 1%
* Skin atrophy 109,115,120 3 (106/1146) 0.95%-11%
Entropion 114 1 (1/160) 0.63%
Cushingoid appearance 115,120 2 (6/1041) 0.45%-1%
Growth retardation 120 1 (4/886) 0.45%
Hypertension 120 1 (1/886) 0.11%
Intralesional
betamethasone+dexamethasone
Bruising at injection site 124 1 (NR/36) NR
32