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Elaine Siegfried, MD
St Louis, Mo

Arch Dermatol. 2002;138:884.

Hemangiomas are the most common tumor affecting infants. Common complications include disfigurement, ulceration, and significant pain. Despite the prevalence of this tumor, its epidemiology is not well documented, its pathogenesis is unclear, and a uniform approach to therapy has not been defined.¹ Topical or systemic corticosteroids are often prescribed during the rapid-growth phase in the first year of life with the expectation of controlling tumor growth. Sixty percent of infantile hemangiomas respond to treatment with corticoids.² Minimal to moderate shrinkage can occur, but brisk involution does not. Insidious adverse effects include irritability, hypertension, and a recent concern about neurodevelopmental impairment.³ Clearly, there is a need for a safe, effective alternative treatment.The use of imiquimod cream for the treatment of infantile hemangiomas is intriguing, and the response observed by these authors impressed them enough to apply for a use patent. However, clinicians must be very cautious about indiscriminately recommending imiquimod cream for this off-label application. Imiquimod has been used anecdotally to treat molluscum, common warts, and condyloma in children without reports of significant adverse effects, but it has not been used extensively in infants, a group at highest risk of percutaneous toxic effects. In addition, the occurrence of erythema and crusting reported in these cases suggests a risk of inducing prolonged ulceration, a complication that has been described in infantile hemangiomas treated with pulsed-dye laser. Until more data are available on the safety and efficacy of this treatment, the optimal candidate for a trial of imiquimod cream is an otherwise healthy infant with 1 or more small, superficial, focal hemangiomas that do not involve high-risk sites (face, hands, feet, or diaper area). Infants should be carefully monitored for quantity of medication, ulceration, pain, and central nervous system adverse effects.

REFERENCES
1. Drolet BA, Esterly NB, Frieden IJ. Hemangiomas in children. N Engl J Med. 1999;341:173-181. FREE FULL TEXT 2. Enjolras O, Riche MC, Merland JJ, Escanda JP. Management of alarming hemangiomas in infancy: a review of 25 cases. Pediatrics. 1990;85:491-498. FREE FULL TEXT 3. AAP Committee on Fetus and Newborn. Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Pediatrics. 2002;109:330-338. FREE FULL TEXT

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