Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Management of Problematic Infantile Hemangioma Using Intralesional Triamcinolone: Efficacy and Safety in 87 Consecutive Infants
Javier A. Couto, BA, Arin K. Greene, MD, MMSc.
Boston Children's Hospital, Boston, MA, USA.

PURPOSE:
Several treatment options exist for a problematic proliferating hemangioma. Intralesional corticosteroid is one method used to limit the rapid growth of the tumor. The purpose of this study was to determine the efficacy and safety of corticosteroid injection for infantile hemangiomas.
METHODS:
The study comprised 87 consecutive patients with a problematic infantile hemangioma managed with intralesional corticosteroid between 2007-2013. Tumors were injected with triamcinolone and followed every 4-6 weeks to determine whether additional injections were indicated. Predictive variables were patient gender, age, location of the hemangioma, tumor depth (superficial, deep, combined), and lesion size. Treatment response was defined as regression, stabilization, or no response. Rebound growth and drug morbidity were recorded.
RESULTS:
Sixty-two females and 25 males were treated. Infantile hemangiomas were located on the lip (29.9%), cheek (21.8%), nose (15.0%), periorbital area (13.8%), forehead (6.9%), chin (2.3%), ear (2.3%), trunk (2.3%), upper extremity (2.3%), scalp (2.3%), and neck (1.1%). Mean tumor size was 2.3 cm2 (range 0.25-16.0cm2); 53.6% were superficial, 14.3% deep, and 32.1% were combined. Treatment was initiated at an average age of 10.8 weeks (range 3-30 weeks). The mean number of injections was 1.9 (range 1-5). The average dose of triamcinolone administered during an injection was 1.63 mg/kg (range 0.76-2.66 mg/kg). All tumors responded to the treatment: 62.1% (n=54) regressed and 37.9% (n=33) stabilized. Forty-three percent of lesions exhibited rebound growth at an average of 3.5 weeks (range 2-7 weeks) following the injection. Gender, location, lesion size, and tumor depth did not affect treatment response (p=0.7). No patient exhibited systemic side effects and 2 lesions (2.0%) had fat atrophy at the site of injection.
CONCLUSION:
The administration of intralesional triamcinolone is an effective treatment for infantile hemangioma. Therapy is safe and infants are not exposed to potential side-effects associated with systemic pharmacotherapy. Corticosteroid injection is our first-line intervention for problematic infantile hemangiomas that are small and localized.
FIGURE 1:
Treatment of problematic nasal hemangioma with intralesional corticosteroid. (A) 3 month old infant with rapidly enlarging nasal hemangioma prior to treatment. (B) Accelerated regression of lesion 2 months following triamcinolone injection. (C) Continual regression of tumor 1 year of age.


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