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Editorial Comment
Elaine Siegfried, MD
St Louis, Mo
Arch Dermatol. 2002;138:316.
Hemangiomas are the most common tumor of infancy, developing in 4% to
10% of neonates. Most are uncomplicated and appropriately managed with monitoring
and counseling, anticipating eventual spontaneous involution with acceptable
outcome. However, a significant minority of infants develop associated complications.
While caregivers are often concerned about the potential for bleeding, hemorrhage
is not common, although disfigurement and ulceration are. These complications
often pose a considerable therapeutic challenge. The pain associated with
ulceration can be significant enough to disrupt family life. Ulceration is
a nidus for infection and precursor to an inevitable scar. Sugarman et al
present a particularly challenging case and a novel approach to treatment
with commercially available recombinant human platelet-derived growth factor-BB
(becaplermin [0.01% Regranex gel]). This product is approved for the treatment
of lower extremity diabetic neuropathic ulcers.
Becaplermin is not approved
for use in children, but absorption has been minimal in adult studies. The
rationale for using becaplermin in this case was to promote tissue repair
and wound healing. Although this infant's refractory ulceration responded
rapidly after initial application of becaplermin, other variables may have
played an important role in wound healing, including hospitalization, more
aggressive wound care, intravenous antibiotics, and adequate pain control.
Anyone considering this treatment should heed the authors' concerns about
the potential to stimulate hemangioma growth.
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