Diagnosis and Management of Infantile Hemangioma

hypopigmentation, impaired wound healing, increased sweating, petechiae and ecchymoses,
rash, sterile abscess, striae, suppressed reactions to skin tests, thin fragile skin, thinning scalp
hair, urticaria, abnormal fat deposits, decreased carbohydrate tolerance, development of
Cushingoid state, hirsutism, manifestations of latent diabetes mellitus and increased requirements
for insulin or oral hypoglycemic agents in diabetics, menstrual irregularities, moon faces,
secondary adrenocortical and pituitary unresponsiveness (particularly in times of stress, as in
trauma, surgery or illness), suppression of growth in children, potassium loss, hypokalemic
alkalosis, sodium retention, abdominal distention, elevation in serum liver enzymes levels
(usually reversible upon discontinuation), hepatomegaly, hiccups, malaise, nausea, pancreatitis,
peptic ulcer with possible perforation and hemorrhage, ulcerative esophagitis, osteonecrosis of
femoral and humeral heads, Charcot-like arthropathy, loss of muscle mass, muscle weakness,
osteoporosis, pathologic fracture of long bones, steroid myopathy, tendon rupture, vertebral
compression fractures, arachnoiditis, convulsions, depression, emotional instability, euphoria,
headache, increased intracranial pressure with papilledema (pseudo-tumor cerebri) usually
following discontinuation of treatment, insomnia, meningitis, mood swings, neuritis, neuropathy,
paraparesis/paraplegia, paresthesia, personality changes, sensory disturbances, vertigo,
exophthalmos, glaucoma, increased intraocular pressure, posterior subcapsular cataracts,
alteration in motility and number of spermatozoa.
We also identified safety data for another steroid evaluated in studies in this review,
mometasone furoate. The use of this medication in pediatric patients (>2 years) is not
recommended for more than 3 weeks. 143 This medication is administered topically, and pediatric
patients will have an increase in the skin surface area to body mass ratio. As a result, adverse
events such as hypothalamic-pituitary-adrenal axis suppression, Cushing’s syndrome, adrenal
insufficiency upon cessation, skin atrophy, striae, linear growth retardation, delayed weight gain,
and intracranial hypertension are more likely to occur in pediatric patients. We report additional
harms data form package inserts and U.S. Food and Drug Administration (FDA) approval
documents in Appendix H.
Effectiveness and Harms of Beta-Blockers
Key Points
Propranolol Versus Observation or Placebo
• In our network meta-analysis, oral propranolol was associated with a mean estimate of
expected clearance of IH of 95% (95% BCI: 88% to 99%) compared with 6 percent (95%
BCI: 1% to 11%) for placebo or observation arms (high SOE for greater effectiveness of
propranolol versus placebo or observation).
• Oral propranolol at doses of 2-3 mg/kg/day divided two to three times daily and given for
up to 6 months promoted resolution or near resolution of IH in children under the age of
12 months with superficial, deep, mixed, or ulcerated IH in most studies.
• Adverse events, measured in the short-term only, associated with these doses of
propranolol in this same population were limited in frequency and severity (moderate
SOE association of propranolol with clinically important and minor harms).
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