Diagnosis and Management of Infantile Hemangioma

Table 9. Adverse effects in case series of steroids to treat IH (continued)
Number Of
Studies
Intervention
Harm/Adverse Event
(# Participants
With Harm/Total
Participants)
Oral prednisone or
prednisolone
Cushingoid appearance 116 1 (44/62) 71%
Diminished weight gain 116 1 (26/62) 42%
Diminished height gain 116 1 (22/62) 35%
Irritable and/or napped less 116 1 (18/62) 29%
Personality change 116 1 (18/62) 29%
Gastric irritation 116 1 (13/62) 21%
Insomnia 116 1 (8/62) 13%
Fungal (oral or perineal) infection 116 1 (4/62) 6%
Recurrent otitis media 116 1 (4/62) 6%
Corticosteroid myopathy 116 1 (1/62) 2%
Hypertension 116 1 (1/62) 2%
Reported Rates
Across Studies
Oral prednisolone Cushingoid appearance 113,120 2 (26/524) 4%-20%
Infection 120 1 (55/499) 11%
Growth retardation 120 1 (21/499) 4%
Hypertension 120 1 (20/499) 4%
Skin atrophy 120 1 (16/499) 3%
Ulceration 120 1 (13/499) 3%
Hypopigmentation 120 1 (7/499) 1%
Oral prednisone Cushingoid appearance 117 1 (32/60) 53%
Behavior changes 117 1 (60/60) 100%
Growth retardation 117 2 (2/60) 3%
Osteoporosis 117 1 (1/60) 2%
IH = infantile hemangioma; n = number; NR = Not reported
* One study 109 reported “atrophy and ulceration.”
** One study of intralesional triamcinolone reported “no systemic side effects.” 123 Another reported unspecified complications in
3/30 children with complicated IH receiving intralesional triamcinolone. 125 Two other studies reported harms in the aggregate
only and not by specific agent 127,129 and are thus not included in this table.
† Two studies reported that there were no adverse effects with intralesional triamcinolone+betamethasone in 42 children with
orbital IH 126 or eyelid IH. 128
Harms Reported in Package Insert Data
The safety and efficacy of pediatric use of corticosteroids has been studied in the literature
for the treatment of nephrotic syndrome (>2 years of age), and aggressive lymphomas and
leukemias (>1 month of age). 134-139 It has been reported that the adverse events identified in
pediatric patients were similar to the events experienced in adults. Monitoring pediatric patients
for blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence
of infection, psychosocial disturbances, thromboembolism, peptic ulcers, cataracts, and
osteoporosis is recommended. Specifically, pediatric patients may have a decrease in growth
velocity after taking corticosteroids by any route of administration. Therefore, children should be
titrated to the lowest effective dose.
Common adverse events of corticosteroids include: fluid retention, alteration in glucose
tolerance, elevation in blood pressure, behavioral and mood changes, increased appetite and
weight gain. 134-142 Additional adverse events include: anaphylactoid reaction, anaphylaxis,
angioedema, bradycardia, cardiac arrest, cardiac arrhythmias, cardiac enlargement, circulatory
collapse, congestive heart failure, fat embolism, hypertension, hypertrophic cardiomyopathy in
premature infants, myocardial rupture following recent myocardial infarction, pulmonary edema,
syncope, tachycardia, thromboembolism, thrombophlebitis, vasculitis, acne, allergic dermatitis,
cutaneous and subcutaneous atrophy, dry scalp, edema, facial erythema, hyper or
33