The steroid benefit in treating complicated hemangioma

Author: Dr. Kamal H. Saleh M.B.CH.B.(F.I.C.M.S.),HEAD

OF PLASTIC SURGERY DPARTMENT IN AL EMADI
HOSPITAL-QATAR-DOHA

Key word: diluted steroid, complicated hemangiomas.

Abstract
The clinical study included (30) patients with
complicated cutaneous hemangioma (ulceration, bleeding,
obstruction of anatomical orifices, & interference with
function or movement). Those patients studied regarding the
age group, sex, site of lesion, size of lesion, & the percentage
of regression after treatment with steroid.
The range of age was from 3 months to 6 years, 20
patients were female & 10 patients were male.
We use local injection of diluted Triamcinolne 4mg with
5ml NACL 0.9% (normal saline), injected by 23gage syringe
under local or general anesthesia every 2 weeks for 6 – 8
sessions depending on the severity of case then applying local
pressure dressing. We measure the size of the lesion before
each session &record the regression of the lesion. The patients
followed for 2 years. Hemangioma commonly present in
infant & children, most commonly in female, especially in
head & neck in small size between (1*1 –2*4). It will regress
early if we start the treatment earlier.

1
 Introduction
Haemangioma are immature rests of vasofomative tissue
that demonstrate angioblastic proliferation & regression
&represent the most common vascular tumor of the
childhood(1). Infantile hemangiooma which is more common
in the females, occur in 10% of the children, usually appear at
birth or with in a few weeks after birth, about (30-90)% of
cases undergoes characteristic proliferation phase that lasts
between 6 – 12 months this proliferative period is followed by
stable phase finally followed by period of regression or
involution (2), usually between the (10-12) years(3). Infants
with the cutaneous hemangioma may treated medically with
high dose of steroid for controlling alarming hemangiomas,
however only 2/3 of these hemangioma regress or stabilized
(4), & well defined surgerybeing planned for esthetic
correction at the age of 8-10 years(5) or improve sign and
symptoms of infantile hemangiomas (6). The size of
hemangioma and the age of initiation of the treatment are the
most important factors affecting the response of treatment (7)..
the site of lesion and the phase of the hemangioma are
affecting too (8). The age of initiation with steroid usually at
7.5 months & the treatment may continue for as long as 5
months (9). Selection type of steroid & the root of
administration & the dose schedules wil be guided by clinical
experience(10), intralesional injection of steroid is an effective
treatment for hemangioma of the head & neck (7), with
injection pressure exceeding the systemic arterial pressure
routinely occur during intralesional injections steroid into
capillary hemangiomas (11).

2
 Patients and methods
Thirty patients with complicated hemangioma
(ulceration, bleeding, obstruction of anatomical orifice, &
interfere with function or movement) of different age groups
collected by simple random sampling in out patient, cases
treated with local injection of diluted triamcinolone 4mg with
5ml normal saline in multiple sessions with 2 weeks apart. The
age of patients were from 3 months – 6 years, 20 patients are
females & 10 patients are males. We used traditional syringe
for injection (23 gage) under local or general anesthesia, then
applying local pressure dressing, we repeat the procedure
every 2 weeks for 6 – 8 sessions depending on the severity of
case, we measure the size of the lesion before each session to
record the regression of the lesion.

Results

In our 30 patients that visit the outpatient clinic, we find that

the most common age group present with hemangioma were
females in about 20 patients compared with males in about 10
patients as shown in figure (1).
Fig (1):- show the sex difference in haemangioma

20
20 10
15
10
.of cases
No

0
Female Male
Sex

Female Male

3
 Also we find that the age presentation to clinic were 10
patients < 1 year, 10 patients from 1 year - < 4years, & 10
patients from 4 years - < 6 years, as shown in the figure (2).

Fig (2):- show the no. of cases of Haemangioma according to the age

10 10 10

10

8
6
of cases

4
No
.

2
0
<1 year 1year-<4years 4years-<6years
Age
<1 year 1year-<4years 4years-<6years

We found that the most common site of hemangioma in

the patients was head & neck in about 51%, the second most
common site was the trunk 33%, the extremities 13%, & the
genitalia 3%, as shown in figure (3).
Fig ( 3 ):- show the most common site of
cutanous hemangioma.

Genitelia
Extremities 3%
13 %

Head & neck

51 %

Trunk
33 %

Head & neck Trunk Extremities Genitelia

4
We found also that 10 patients the size of cutaneous
hemangioma was (1*1cm), 8 patients was (1*3cm), 7 patients
was (2*4cm), & 5 patients was (3*5cm), as shown in the table
(1).

Number of cases Size in cm

10 cases 1*1 cm

8 cases 1*3 cm

7 cases 2*4 cm
5 cases 3*5 cm

After treatment we found that the 60% of cutaneous

heamangioma regress in age group between 1-<2 years old,
from 2-4 years old regress in about 40%, & >6 years old is
about 25% as shown in table (2).

Age of patient % of regression No. of patients

1 - <2 years 60% 10
2–4 40% 10
>6 25% 10

5
 We found that only three patients suffer from the
complication of steroid treatment, as shown in figure (4).

Fig ( 4 ):- show the complications after treatment of haemangioma

2cases

2
1 case
1.5
of cases

1
No

0.5
.

0
infection 1

moon
face

type of complication
infection moon face

Discussion
In our (30) patients of cutaneous haemangioma, we
found that the most common age group presented with
hemangioma was in infant & children (3 months – 6 years) in
all patients we treat this agrees with the study of Winter-H,
etal. Who found that 65.3 % was infant & children.(3)
The female to male ratio was found to be 2:1, this agrees
with the Garzon-M who found that hemangioma occur in
female 3 times more than male.(9)
Hemangioma present commonly in head & neck region
in about (51%), then trunk in (33%), extremities in (13%), &
genitalia in (3%). This agrees with the study conducted by
Mullkin & Glowacki, who found that (60%) of hemangioma
are in the head and neck area, (25%)in the trunk, & (15%) in
the extremities.(12)

6
 We found that the majority of hemangioma was small in
size in about (83.3%) in 25 patients & (16.7%) in 5 patients.
This agrees with the study of Garzon-M.(9)
After treatment with local steroid the percentage of
regression was found to be (60%) when we start the treatment
in early period 3 months - <2years, (40%) from 2 - <4 years,&
(25%) from 4 – 6 years. This agrees with the Akyus – C, etal,
who found that the age of initiation of treatment is the most
important factor affecting the response to treatment.(1`)

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7
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