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An Evidence-Based Evaluation

Michelle L. Bennett, MD; Alan B. Fleischer, Jr, MD; Sarah L. Chamlin, MD; Ilona J. Frieden, MD

Arch Dermatol. 2001;137:1208-1213.

Objectives  To determine the efficacy of systemic corticosteroid therapy in treating enlarging, problematic cutaneous hemangiomas and to assess the relationship of dose to response and adverse effects.

Design  A quantitative systematic literature review was performed and inclusion and exclusion criteria were applied.

Setting  Patients were treated in primary care, referral centers, and institutional practices. Most patients were ambulatory, although some required hospitalization.

Patients  Inclusion criteria were original case series with a minimum of 5 patients with enlarging, problematic cutaneous hemangiomas treated with systemic corticosteroids. Exclusion criteria were being older than 2 years, receiving simultaneous other treatments, being lost to follow-up, or having insufficient information. Twenty-four original case series met inclusion criteria; 10 case series remained (184 patients) after exclusion criteria were applied.

Intervention  Patients were given a mean prednisone equivalent daily dose of 2.9 mg/kg (95% confidence interval [CI], 2.7-3.1 mg/kg) for a mean of 1.8 months (95% CI, 1.5-2.2 months).

Main Outcome Measures  Response and rebound rates and dose-response and adverse effects–response relationships in responders vs nonresponders.

Results  Response was 84% (95% CI, 78%-89%; range, 60%-100%) and rebound was 36% (95% CI, 29%-44%; range, 0%-65%). A significant difference was found between the mean dose administered to responders vs nonresponders (P<.001). No significant difference was observed as to the occurrence of adverse effects (P = .3).

Conclusion  Systemic corticosteroid treatment seems to be effective for problematic cutaneous hemangiomas of infancy.

From the Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC (Drs Bennett and Fleischer); and the Departments of Dermatology and Pediatrics, University of California–San Francisco (Drs Chamlin and Frieden).

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