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August 2004

Adverse Effects of Systemic Glucocorticosteroid Therapy in Infants With Hemangiomas

Author Affiliations

From the Sections of Dermatology (Drs George, Sharma, and Nopper), Endocrinology (Dr Jacobson), and Research and Statistics (Dr Simon), Children's Mercy Hospital, Kansas City, Mo. The authors have no relevant financial interest in this article.

Arch Dermatol. 2004;140(8):963-969. doi:10.1001/archderm.140.8.963

Objective  To evaluate the short- and long-term adverse effects of systemic glucocorticosteroid (GS) therapy in infants with hemangiomas.

Design  Retrospective chart review of infants treated with GSs for hemangiomas during a 3-year period.

Setting  Tertiary care children's hospital

Patients  Of 141 patients identified with hemangiomas, 22 were treated with GSs.

Interventions  Minimum of 1-month GS therapy at a minimum starting dose of 0.5 mg/kg per day.

Outcome Measures  Demographic and anthropometric measurements, starting dose and duration of GS therapy, subjective parental concerns, complications related to hemangioma, adjunctive treatment, and morning cortisol levels and/or results of corticotropin stimulation tests.

Results  The average starting dose was 2.23 mg/kg per day; average length of therapy was 28.1 weeks. Complaints of irritability, fussiness, or insomnia were identified in 16 patients (73%). Hypertension, defined as 3 or more episodes of systolic blood pressure higher than 105 mm Hg, was observed in 10 patients (45%). Morning cortisol levels were abnormal in 13 (87%) of the 15 patients evaluated. Low-dose corticotropin stimulation test results were abnormal in 2 of the 3 infants tested.

Conclusions  While GS therapy for infantile hemangiomas was tolerated well overall, changes in behavior, insomnia, and gastrointestinal symptoms were common parental concerns. Hypertension and hypothalamic-pituitary-adrenal axis suppression were observed frequently. Infants undergoing long-term GS treatment of hemangiomas should be monitored carefully for these potential adverse effects.