Oral Corticosteroid Use is Effective for Cutaneous Hemangiomas: an Evidence-based Evaluation

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.