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Topical imiquimod in the treatment of infantile hemangiomas: A retrospective study

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Background

Active nonintervention remains the mainstay of therapy for most uncomplicated infantile hemangiomas (IH) because of their expected involution. Topical imiquimod, with its ability to induce the production of interferon, tumor necrosis factor-α, and the antiangiogenesis factor tissue inhibitor of matrix metalloproteinase, has been recently reported to be efficacious in the treatment of IH.

Objective

We sought to evaluate the efficacy of imiquimod 5% cream in the treatment of noncomplicated IH and possible side effects.

Methods

A retrospective chart review analysis was performed in 18 children (16 girls and 2 boys) with a median age of 18 weeks (range: 4-256 weeks). A total of 22 hemangiomas (14 located on head, 3 on genitalia, 2 on trunk, and 3 on extremities) were treated with imiquimod 5% cream. Imiquimod was applied 3 times weekly in 10 patients and 5 times weekly in 8 patients for a mean duration of 17 weeks (7-46 weeks).

Results

All superficial IH improved, and remission was achieved in 4 hemangiomas. There was little improvement in mixed IH with no or minimal change in all deep hemangiomas. One case with ulcerated hemangioma substantially improved with accelerated ulcer healing and hemangioma size reduction. No systemic complication was observed in any of our patients, with irritation and crusting being the most common reactive effects.

Limitations

The small-sample, retrospective study limits the interpretation of results.

Conclusion

Imiquimod 5% cream may be most effective in superficial IH. There was no significant correlation between response and early onset of treatment for any IH in our small sample study. Pharmacokinetic analysis and placebo-controlled study should follow to ascertain the safety and efficacy of imiquimod 5% cream in the pediatric age group.

Section snippets

Study patients

The study was conducted in the dermatology clinic of our tertiary academic referral center. The study received ethical approval from the research ethics board. Patients were identified by searching through the dermatology database for diagnoses of IHs. In this retrospective study, only patients treated with topical imiquimod were included.

Methods

Data collection included demographic characteristics, age of onset of the hemangioma, physical examination, and response to therapy as documented by digital

Results

A total of 18 children, 16 girls and 2 boys, with a median age of 18 weeks (range: 4-256 weeks) were included. Most patients were treated during the proliferative phase (4-48 weeks); two patients with deep IH (cases 16 and 17) had the treatment commenced during the involuting phase (256 and 204 weeks, respectively) to assess if topical imiquimod could influence their involution, as no previous data had been formulated on its efficacy in this phase. Two patients had more than one hemangioma. In

Discussion

The pathogenesis of hemangiomas is not well understood. However, the angiogenesis-dependent tumors concept was widely postulated and supported by many studies.7, 8, 9, 10, 11, 12 Cell marker studies showed antibodies to angiogenesis promoters such as proliferating cell nuclear antigen, vascular endothelial growth factor, basic fibroblast growth factor, and type IV collagenase preferentially staining sections from hemangiomas22 and adjacent normal tissue,23 and insulin-like growth factor-224 in

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    Funding sources: None.

    Conflicts of interest: None identified.

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