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Kim S, Woo YR, Cho SH, Lee JD, Kim HS. Clinical Efficacy of 5-Fluorouracil and Bleomycin in Dermatology. J Clin Med 2024; 13:335. [PMID: 38256469 PMCID: PMC10816055 DOI: 10.3390/jcm13020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Bleomycin and 5-fluorouracil (5-FU) are widely used in various dermatological disorders. Both drugs are well-recognized as antineoplastic drugs and exert their effect by blocking the cell cycle. Topical and intralesional formulations are available and have been studied in both non-neoplastic and cancerous lesions. However, data comparing the effect of bleomycin and 5-FU in the dermatological disorders are limited. This review outlines the action mechanisms of both drugs and compares their clinical efficacies in a wide range of dermatologic diseases including hypertrophic scar, wart, skin cancer, vascular malformation, hemangioma, and vitiligo, and discusses the overall safety of the drugs. Intralesional bleomycin treatment is effective in hypertrophic scars and warts, but intralesional 5-FU may also be considered since it is cheaper and less painful. Moreover, intralesional 5-FU and bleomycin injection is a viable option for premalignant lesions (i.e., actinic keratosis) and inoperable skin cancers. Both bleomycin and 5-FU have been applied as treatment adjuncts for vitiligo, with 5-FU showing a slightly better outcome. Both agents have a good safety profile, and no serious side effects have been reported following their use in the field of dermatology.
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Affiliation(s)
| | | | | | | | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (Y.R.W.); (S.H.C.); (J.D.L.)
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Guo L, Wang M, Song D, Sun J, Wang C, Li X, Wang L. Additive value of single intralesional bleomycin injection to propranolol in the management of proliferative infantile hemangioma. Asian J Surg 2024; 47:154-157. [PMID: 37328380 DOI: 10.1016/j.asjsur.2023.05.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND /Objective: We aimed to evaluate whether additional intralesional bleomycin injections benefit children with proliferative infantile hemangiomas (IHs). METHODS In this retrospective case-control study, we examined the medical records of 216 infants who were followed up for proliferative IH. Patients in group 1 were treated with propranolol orally at 2 mg/kg/day. Group 2 was treated with oral propranolol combined with intralesional bleomycin injections. RESULTS We retrospectively reviewed 95 and 121 patients in groups 1 and 2, respectively. No significant differences were observed between both groups regarding visiting age, sex, lesion thickness, or risk site. The overall cure rates in groups 1 and 2 were 77.89% (74/95) and 84.30% (102/121), respectively. The overall distribution of the length of cure significantly differed between both groups (P = 0.035). From the survival analysis (P = 0.026), the median survival time was 198 days (95% confidence interval (CI) 174.46-221.54) for group 1 and 139 days (95% CI 114.58-163.42) for group 2. The effect of treatment modality (hazard ratio (HR) = 1.41, P = 0.031) and risk site on survival time (HR = .54, P < 0.001) was significant. CONCLUSION No significant differences were observed in the resolution of proliferative IH; however, intralesional bleomycin injection with systemic propranolol for proliferative IH treatment may provide a more rapid resolution.
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Affiliation(s)
- Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
| | - Ming Wang
- Department of Hospital Office, QiLu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, China.
| | - Dan Song
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
| | - Jiali Sun
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
| | - Changfeng Wang
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
| | - Xiaojuan Li
- Department of Hospital Office, QiLu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, China.
| | - Liang Wang
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
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Narang E, Jain N, Kaur J, Roy S, Singh J. Conservative treatment of Head and Neck hemangiomas using Intralesional Bleomycin. Indian J Otolaryngol Head Neck Surg 2023; 75:236-240. [PMID: 37275108 PMCID: PMC10235280 DOI: 10.1007/s12070-022-03133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/19/2022] [Indexed: 10/14/2022] Open
Abstract
Background Hemangiomas are vascular tumours and commonly occur in head and neck region. Complete treatment of these vascular swellings are often challenging. As surgical excision carries high risk of complications and poor cosmetic outcome, treatment is shifted more towards non-surgical modalities like steroid therapy, radiotherapy, chemotherapy and sclerotherapy. Objective To study the efficacy of intralesional Bleomycin sclerotherapy for head and neck hemangiomas. Method Seventeen patients ( 9 males and 8 females) with head and neck hemangiomas were treated with sclerotherapy using intralesional bleomycin injection ( 0.1-0.5 mg/kg/ dose) in a medical college of India. Details of the patients were recorded along with serial photographs of lesion. Post injection outcomes in form of reduction of lesion size, patient satisfaction and complications were also recorded. Results 11 patients were completely cured, 3 had more than 50% reduction in size, one patient showed minimal reduction and two had no response. One patient had superficial ulceration, one case of slough and fever was reported. None of the patients developed severe toxic side effects and pulmonary fibrosis with follow up of 18 months. Conclusions Bleomycin injection is safe, easy and well tolerated method for treatment of head and neck hemangiomas. We recommend surgery only if there is no response to other conservative treatment modalities.
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Affiliation(s)
- Ekta Narang
- Department of Otorhinolaryngology, Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi, India
| | - Neha Jain
- Department of Otorhinolaryngology, Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi, India
| | - Jaswinder Kaur
- Department of Otorhinolaryngology, RML Hospital, Delhi, India
| | - Suparna Roy
- Department of Otorhinolaryngology, Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi, India
| | - Jyoti Singh
- Department of Otorhinolaryngology, Chacha Nehru Bal Chikitsalaya Geeta Colony, Delhi, India
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Nazemian S, Sharif S, Childers ELB. Infantile Hemangioma: A Common Lesion in a Vulnerable Population. Int J Environ Res Public Health 2023; 20:ijerph20085585. [PMID: 37107867 PMCID: PMC10139075 DOI: 10.3390/ijerph20085585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/08/2023] [Accepted: 03/29/2023] [Indexed: 05/11/2023]
Abstract
Infantile hemangioma (IH) is important to all dentists, particularly dentists providing services to pediatric populations, because significant morbidity and mortality can occur from vascular lesions in children. Specialists of the oral cavity have the responsibility to identify patients with IH, a lesion that could be potentially life threatening. We present a case of IH and will provide a narrative review of the most recent literature. We discuss the diagnosis, risk stratification, treatment, complications, and impact on routine dental procedures. A proper diagnosis is crucial as oral and perioral IH are considered high-risk due to the increased risk of ulceration and feeding impairment. Referral to a hemangioma specialist for comprehensive team treatment is optimal. The natural history of IH consists of a long proliferative phase, which manifests as clinically visible growth. As a result of early encounters with patients, the pediatric dentist may often be considered the primary care provider.
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Affiliation(s)
- Samon Nazemian
- Pediatric Dentistry Resident Department of Pediatric Dentistry, College of Dentistry Howard University, Washington, DC 20059, USA
| | - Shohreh Sharif
- Greater Washington Dentistry, 3700 Joseph Siewick Drive, Fairfax, VA 22033, USA
| | - Esther L. B. Childers
- Department Oral and Maxillofacial Pathology, College of Dentistry Howard University, Washington, DC 20059, USA
- Correspondence:
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Pandey A, Srivastava A, Pant N, Singh S, Rawat J. Intralesional steroid in the era of propranolol for infantile hemangioma-Do we need it? J Plast Reconstr Aesthet Surg 2023; 77:117-122. [PMID: 36566639 DOI: 10.1016/j.bjps.2022.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 10/06/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite its effectivity, there are reports of poor response to propranolol in the treatment of infantile hemangioma (IH). The literature is limited to the type of IH that fails to respond to propranolol. This study was conducted to analyze which types of hemangiomas respond poorly to propranolol and the effects of intralesional triamcinolone (IL TMC) in them. MATERIAL AND METHODS In this prospective cohort study, IH was classified as superficial, deep, and mixed. The clinical details were recorded. Propranolol was started in the patients at a dose of 1 mg/kg/day and increased to 2-3 mg/kg/day. The response to the treatment was evaluated as excellent, good, poor, and no response. IL TMC was given in the non-responding group at a dose of 1-2 mg/kg at one-month interval for a total of six doses after stopping propranolol. RESULTS Ninety-six patients (median age, 7 months; M/F = 2:1) were treated. Superficial hemangioma was present in 40 (41.7%), deep in 10 (10.4%), and mixed in 46 (47.9%) patients. The response was statistically better if initiated within four months of age. It was not influenced by the sex, number, site, or size. The response was statistically better in superficial hemangioma. IL TMC was administered in the 16 patients. The response was good or excellent in 10 patients. CONCLUSION Propranolol will be used as a first-line drug for IH. All superficial IHs are likely to respond. There will be a possibility of non-responding mixed or deep IH. Use of IL TMC seems reasonable for IH not responding to propranolol.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India.
| | - Anurag Srivastava
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India
| | - Nitin Pant
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India
| | - Sudhir Singh
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India
| | - Jiledar Rawat
- Department of Pediatric Surgery, King George's Medical University, Lucknow, 226003, UP, India
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Tiwari P, Bera RN, Pandey V. Bleomycin-triamcinolone sclerotherapy in the management of propranolol resistant infantile hemangioma of the maxillofacial region: A single arm prospective evaluation of clinical outcome and Doppler ultrasound parameters. J Stomatol Oral Maxillofac Surg 2023; 124:101313. [PMID: 36261060 DOI: 10.1016/j.jormas.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Propranolol has emerged as a first line agent in the management of hemangiomas. With increased use of propranolol, studies have also focused on relapses following propranolol therapy. Our current study evaluates the role of bleomycin triamcinolone sclerotherapy for the management of propranolol resistant Infantile Hemangioma (IH). We also evaluated the role color Doppler USG for response assessment of sclerotherapy. METHODS Patients with Propranolol resistant (Non- responders/ Partial responders) IHs were included in the study. Patients received intralesional bleomycin at a dose of 0.5 IU/kg followed by intralesional injection of triamcinolone at a dose of 2mg/kg body weight. Clinically patients were grouped into excellent, partial and non responders. Doppler parameters; Resistivity index (RI), Pulsatility index(PI) and Peak systolic velocity (PSV) were used to evaluate the response to sclerotherapy. These parameters were evaluated prior to sclerotherapy and 3 months following completion of therapy. The clinical responses of the patients were compared with the change in Doppler parameters before and after treatment. RESULTS A total of 115 participants were considered for analysis; 60.86% had excellent response, 32.17% had partial response and 6.95% had poor response. There was a significant change in terms of RI, PI and PSV in patients who were either excellent or partial responders. Poor responders did not have a significant change in Doppler parameters. CONCLUSION Combined bleomycin- triamcinolone sclerotherapy is an effective therapy for the management of propranolol resistant IHs. Doppler parameters RI, PI and PSV are reliable indicators of response in the management of IH.
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Affiliation(s)
- Preeti Tiwari
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Rathindra Nath Bera
- Department of Oral and Maxillofacial Surgery, Dental College Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.
| | - Vaibhav Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
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Chiramel M, Katakam B, Gulati R, Gupta M, Munisamy M, S. Ranugha PS, Seetharam KA. IADVL SIG pediatric dermatology (academy) recommendations on Hemangioma of Infancy (HOI). Indian Dermatol Online J 2023; 14:172-186. [PMID: 37089858 PMCID: PMC10115319 DOI: 10.4103/idoj.idoj_52_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 03/12/2023] Open
Abstract
Hemangioma of infancy (HOI) is a benign vascular proliferation. Though resolution is the norm, potential complications make an accurate diagnosis and early management of importance. The Indian association of dermatologists, venereologists and leprologists (IADVL) special interest group (SIG) paediatric dermatology in association with IADVL academy did an extensive analysis of the literature on the clinical features, diagnosis, and management of HOI published between 2010 and 2021. Online meetings were conducted from February 2021 to March 2022 to reach a consensus on these recommendations which are made from an Indian perspective.
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Tiwari P, Pandey V, Bera RN, Tiwary N, Mishra A, Sharma SP. Sandwich therapy in the management of propranolol resistant infantile hemangioma of the lip. J Stomatol Oral Maxillofac Surg 2022; 123:e499-e505. [PMID: 35217221 DOI: 10.1016/j.jormas.2022.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/15/2022] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
RATIONALE Propranolol has evolved as a first line management of infantile haemangiomas. Nevertheless, the resistance to propranolol has warranted alternative treatment modalities. We hypothesize that combination of medical and surgical therapy (sandwich therapy) to be beneficial in the management. METHODS Patients were divided into three groups (total=31), Group A (bleomycin sclerotherapy), Group B (surgical group), Group C (sandwich therapy). A p value <0.05 was taken as significant. RESULTS In Group A 54.5% of patients had excellent response, 27.3% partial response and 18.2% had no response. Comparing cosmetic outcome, 25% of patients in Group B and 16.7% of patients in Group C had excellent upshot. On the contrary 18.2% of patients in bleomycin had unsatisfactory and 18.2% had poor cosmetic outcome. Sandwich therapy was cosmetically more acceptable than Bleomycin sclerotherapy (p- value = 0.049). In terms of recurrence, sandwich therapy differed significantly from surgical therapy with fewer recurrences (p-value= 0.049). CONCLUSION Sandwich therapy is superior to bleomycin sclerotherapy in terms of cosmetic outcome and has fewer recurrences compared to surgical group and requires single stage resection. However, further studies with the help of Doppler ultrasound are required in this regard.
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Affiliation(s)
- Preeti Tiwari
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University Varanasi 221005, India
| | - Vaibhav Pandey
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Rathindra Nath Bera
- Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University Varanasi 221005, India.
| | - Narendra Tiwary
- Department of Community Medicine, RG KAR medical college and hospital, Kolkata, India
| | - Akash Mishra
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
| | - Shiv Prasad Sharma
- Department of Pediatric surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India
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Abstract
Infantile hemangioma (IH) is the most common benign vascular tumor of infancy, affecting about 5% of infants. It has a characteristic growth pattern of early rapid proliferation followed by progressive involution. Although most IH evolve favorably, complications are observed in 10-15% of cases, justifying treatment. For over 10 years now, propranolol has become the first-line therapy for complicated IH, revolutionizing their management and their prognosis. In this article, we review the clinical features, associations, complications/sequelae and therapeutic approaches for IH, focusing on current medical therapy. Indications for treatment and various treatment options, including propranolol and other oral β-blockers, topical timolol, and corticosteroids are presented. Current controversies regarding oral propranolol such as pre-treatment screening, in- vs out-patient initiation of treatment, early and potential long-term side effects and recommended monitoring are discussed.
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Affiliation(s)
- Caroline Colmant
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada.
| | - Julie Powell
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
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Pandey V, Tiwari P, Imran M, Mishra A, Kumar D, Sharma SP. Adverse Drug Reactions Following Propranolol in Infantile Hemangioma. Indian Pediatr 2021; 58:753-5. [DOI: 10.1007/s13312-021-2286-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Sebaratnam DF, Rodríguez Bandera AL, Wong LCF, Wargon O. Infantile hemangioma. Part 2: Management. J Am Acad Dermatol 2021; 85:1395-1404. [PMID: 34419523 DOI: 10.1016/j.jaad.2021.08.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/25/2021] [Accepted: 08/03/2021] [Indexed: 12/18/2022]
Abstract
The majority of infantile hemangiomas (IH) can be managed conservatively, but for those requiring active treatment, management has been revolutionized in the last decade by the discovery of propranolol. Patients that may require active intervention should receive specialist review, ideally before 5 weeks of age to mitigate the risk of sequelae. Propranolol can commence for most infants in the outpatient setting and the most frequently employed dosing regimen is 1 mg/kg twice daily. In the future, β-blockers with a more-selective mechanism of action, such as atenolol, show some promise. In recalcitrant lesions, systemic corticosteroids or sirolimus may be considered. For small, superficial IHs, topical timolol maleate or pulsed dye laser may be considered. Where the IH involutes with cutaneous sequelae, a range of interventions have been reported, including surgery, laser, and embolization. IHs have a well-described clinical trajectory and are readily diagnosed and managed via telemedicine. Algorithms have been constructed to stratify those patients who can be managed remotely from those who warrant in-person review during the COVID-19 pandemic.
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Affiliation(s)
- Deshan F Sebaratnam
- The Children's Hospital at Westmead, Sydney, Australia; Liverpool Hospital, Sydney, Australia.
| | | | | | - Orli Wargon
- Sydney Children's Hospital, Sydney, Australia
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Luca AC, Miron IC, Trandafir LM, Cojocaru E, Pădureţ IA, Trandafirescu MF, Iordache AC, Ţarcă E. Morphological, genetic and clinical correlations in infantile hemangiomas and their mimics. Rom J Morphol Embryol 2021; 61:687-695. [PMID: 33817710 PMCID: PMC8112746 DOI: 10.47162/rjme.61.3.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Infantile hemangiomas (IHs) are the most frequent pediatric benign vascular tumors, with a reported incidence of 5% to 10%. They have self-limiting evolution pattern divided into a growth phase in the first 12 months and a regression one, that may take up to 10 years. Occasionally, hemangiomas might lead to local or systemic complications, depending on their morphological characteristics. The first line of treatment is β-blockers, such as Propranolol, Timolol, Nadolol, administered either locally or systemically. Newer therapeutic strategies involving laser therapy and angiotensin-converting enzyme inhibitors are being studied, while older treatment modalities like corticosteroids, Imiquimod, Vincristine, Bleomycin and Interferon-α have become second line therapy options. Before establishing the appropriate treatment, clinical, histological, and imaging investigations are required.
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Affiliation(s)
- Alina Costina Luca
- Department of Morphofunctional Sciences I - Pathology, Department of Mother and Child Medicine - Pediatrics, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; ,
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Tiwari P, Kumar R, Pandey V, Kar A, Tiwary N, Sharma S. A clinicopathological study to assess the role of intralesional sclerotherapy following propranolol treatment in infantile hemangioma. J Cutan Aesthet Surg 2021; 14:409-415. [PMID: 35283595 PMCID: PMC8906266 DOI: 10.4103/jcas.jcas_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wang X, Feng W, Zhao X, Liu Z, Dong L. The Efficacy and Safety of Topical β-Blockers in Treating Infantile Hemangiomas: A Meta-Analysis Including 11 Randomized Controlled Trials. Dermatology 2020; 237:433-443. [PMID: 33027794 PMCID: PMC8117385 DOI: 10.1159/000510029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of topical β-blockers in the treatment of superficial infantile hemangiomas (SIH) and mixed infantile hemangiomas (MIH), respectively, and compare the efficacy and safety of topical β-blockers with other interventions. METHODS The PRISMA guidelines were adhered to. We searched for randomized controlled trials in databases from 2010 to 2018 comparing topical β-blockers with other interventions for infantile hemangiomas. The outcomes evaluated were efficacy and adverse effects. Data analyses were performed using RevMan 5.3. Publication bias was assessed to account for bias in patient selection. RESULTS Eleven studies, involving 1,235 patients, were subjected to this meta-analysis. Six studies compared topical β-blockers with other interventions (propranolol, placebo, corticosteroids or pulsed dye laser) in treating SIH, and 5 studies evaluated the efficacy and safety of a topical β-blocker when it was combined with another intervention in treating MIH. A topical β-blocker was discovered to be as effective as oral propranolol in treating SIH (risk ratio, RR, 0.96, 95% confidence interval, CI, 0.91-1.02, p = 0.20, I2 = 0%), and topical β-blockers were more beneficial than placebo, corticosteroids or pulsed dye laser in treating SIH (RR 2.25, 95% CI 1.66-3.05, p < 0.00001, I2 = 0%). Topical β-blockers combined with another intervention gave rise to a better clinical response in the treatment of MIH than intervention alone (RR 1.99, 95% CI 1.10-3.60, p = 0.02, I2 = 55%) (standard mean difference 0.80, 95% CI 0.28-1.31, p = 0.002, I2 = 0%). Compared with oral propranolol, topical β-blockers were associated with fewer incidences of adverse effects (RR 0.05, 95% CI 0.01-0.39, p = 0.004, I2 = 0%). No significant difference in adverse effects was found when a topical β-blocker was combined with another intervention in treating MIH (RR 1.01, 95% CI 0.58-1.74, p = 0.98, I2 = 0%). CONCLUSIONS This meta-analysis provided evidence that topical β-blockers may replace oral propranolol as first-line therapy for SIH and that they are of additive value in treating MIH.
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Affiliation(s)
- Xinhui Wang
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Wei Feng
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Xufeng Zhao
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Ziyu Liu
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Liang Dong
- Department of Pediatric Surgery, Tianjin Children's Hospital, Tianjin, China,*Liang Dong, E-Mail
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Chang SJ, Qian L, Yang X, Lee HY, Chen H, Ma G, Qiu Y, Lin X. Intralesional bleomycin injection for localized verrucous venous malformations. J Am Acad Dermatol 2020; 85:991-992. [PMID: 32956740 DOI: 10.1016/j.jaad.2020.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Shih-Jen Chang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Lili Qian
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China; Department of Plastic Surgery and Burns, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, People's Republic of China
| | - Xi Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Han-Yu Lee
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Gang Ma
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yajing Qiu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
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Abstract
Infantile hemangioma (IH) is the most common vascular tumor of infancy, affecting as many as 5% to 10% of all infants. The exact cause is unclear, but specific risk factors, such as low birth weight, prematurity, female sex, white race, and family history are associated with IH development. Most IHs are benign and self-resolving, but a small subset of patients with IHs are at risk of severe or life-threatening outcomes. Systemic and topical β-blockers are effective and safe for use in pediatric patients and considered first-line treatment for both complicated and uncomplicated IHs. Recently published guidelines provide a thorough review of IH and management. This article focuses on IH pharmacotherapy and provides practice pearls to support health care providers in IH medication management.
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Wang L, Zheng K, Li X, Wang Y, Xu Q. Influence of Cytochrome P450 2D6 Polymorphisms on the Efficacy of Oral Propranolol in Treating Infantile Hemangioma. Biomed Res Int 2020; 2020:8732871. [PMID: 32219146 DOI: 10.1155/2020/8732871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 01/05/2023]
Abstract
Objective The aim of this study is to evaluate the association of genetic polymorphisms in Cytochrome P450 2D6(CYP2D6) and the change in VEGF levels with the response to propranolol in patients with Infantile hemangiomas (IH). Methods IH patients who underwent over six months of propranolol therapy and received oral propranolol only were enrolled. The target dose of propranolol was 1 mg kg-1day-1. Deoxyribonucleic acid was obtained from venous blood leukocytes. Genotypes of CYP2D6 (rs1065852 and rs1135840) were tested by polymerase chain reaction (PCR) and by sequencing the products. Baseline serum VEGF and serum VEGF one month after treatment were measured. The clinical responses after six months of treatment were evaluated. Genotypes of CYP2D6 (rs1065852 and rs1135840) and VEGF levels were compared between good responders and poor-to-moderate responders. Results 72 patients were enrolled in the study. Patients with CYP2D6 (rs1135840) G/G homozygote had the highest response rate to propranolol. No significant association was found between the response rates and CYP2D6 (rs1065852) polymorphism. No significant differences were found in baseline serum VEGF, serum VEGF one month after treatment, and VEGF ratio between good responders and poor-to-moderate responders. Conclusion The response to propranolol treatment in IH patients was associated with the gene polymorphism of CYP2D6 (rs1135840). A low-dose propranolol regimen was effective and safe in young infants with IH. The change of serum VEGF levels after one month's treatment could not be used to predict the response rate to propranolol.
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Zhang JW, Yin SY, Zhou DK, Wen JX, Gao H, Chen L, Wang ZX. Quantitative Evaluation of Percutaneous Local Drug Perfusion Against Refractory Infantile Hemangioma via 3-D Power Doppler Angiography. Ultrasound Med Biol 2020; 46:610-619. [PMID: 31810804 DOI: 10.1016/j.ultrasmedbio.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 10/26/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
To assess the practicality of 3-D power Doppler angiography (3-D-CPA) for local drug perfusion dosage guidance of refractory infantile hemangioma (IH) treatment, 47 cases (48 lesions) of refractory IH were selected for local bleomycin infusion (once a month). Ultrasound was performed before treatment and 1 and 2 months after the first treatment. The 3-D volume (V) change of infantile hemangiomas and the ratio of bleomycin injection to 3-D V before treatment were calculated, and statistical analysis was performed. One month after percutaneous local drug perfusion, 37 participants (77.08%) exhibited significant improvement; controlled growth was observed on six lesions (12.5%); and treatment of the remaining 5 lesions (10.42%) failed to suppress growth. The calculated tolerable and effective dose of bleomycin for refractory IH was 0.34 ± 0.03 mL/cm3; the corresponding 3-D V decreased approximately 70.27 ± 6.27%. Three-dimensional CPA can provide abundant information on internal lesions. In particular, 3-D-CPA can quantitatively assess changes in lesion volume and guide the effective and rational use of interventional drugs.
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Affiliation(s)
- Jin-Wei Zhang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shu-Yue Yin
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - De-Kai Zhou
- Department of Hemangioma, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jie-Xin Wen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hui Gao
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lu Chen
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhao-Xia Wang
- Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Bik L, Sangers T, Greveling K, Prens E, Haedersdal M, van Doorn M. Efficacy and tolerability of intralesional bleomycin in dermatology: A systematic review. J Am Acad Dermatol 2020; 83:888-903. [PMID: 32068046 DOI: 10.1016/j.jaad.2020.02.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 11/20/2022]
Abstract
Bleomycin is widely used as an off-label treatment for various dermatologic indications. However, a much-needed critical appraisal of the currently available evidence is lacking. We therefore evaluated the quality of clinical evidence for the efficacy and safety of intralesional bleomycin treatment for dermatologic indications with the aim to provide evidence-based recommendations for clinical practice. The PubMed, Embase, Medline Ovid, Web of Science, Cochrane Central, and Google Scholar databases were systematically searched. Two authors independently selected relevant studies according to predefined inclusion and exclusion criteria. We assessed the methodologic quality with the Cochrane Collaboration risk-of-bias assessment tool and selected 10 randomized clinical trials and 15 clinical controlled trials. Treatment indications included common warts, nonmelanoma skin cancer, cutaneous metastases, keloid and hypertrophic scars, and hemangioma. Intralesional bleomycin treatment showed significantly higher cure rates for warts compared with other treatments. Local adverse events included erythema, blackening, eschar formation, and superficial ulceration. None of the studies reported systemic adverse events. Methodologic quality of the studies was generally low. Consequently, no firm recommendations can be made for intralesional bleomycin treatment in clinical practice. However, this review suggests that intralesional bleomycin is a successful and well-tolerated treatment for recalcitrant warts.
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Chen ZY, Wang QN, Zhu YH, Zhou LY, Xu T, He ZY, Yang Y. Progress in the treatment of infantile hemangioma. Ann Transl Med 2019; 7:692. [PMID: 31930093 PMCID: PMC6944559 DOI: 10.21037/atm.2019.10.47] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023]
Abstract
Infantile hemangioma (IH) is a common benign tumor, which mostly resolves spontaneously; however, children with high-risk IH need treatment. Currently, the recognized first-line treatment regimen for IH is oral propranolol, but research on the pathogenesis of IH has led to the identification of new therapeutic targets, which have shown good curative effects, providing more options for disease treatment. This article summarizes the applications of different medications, dosages, and routes of administration for the treatment of IH. In addition to drug therapy, this article also reviews current therapeutic options for IH such as laser therapy, surgical treatment, and observation. To provide the best treatment, therapeutic regimens for IH should be selected based on the child's age, the size and location of the lesion, the presence of complications, the implementation conditions, and the potential outcomes of the treatment.
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Affiliation(s)
- Zhao-Yang Chen
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Qing-Nan Wang
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yang-Hui Zhu
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Ling-Yan Zhou
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Ting Xu
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Zhi-Yao He
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yang Yang
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
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Mazereeuw-hautier J. Quoi de neuf en dermatologie pédiatrique? Ann Dermatol Venereol 2018; 145:VIIS32-VIIS46. [DOI: 10.1016/s0151-9638(18)31287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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