Steroids & Hemangioma
Glucocorticosteroids-Medications commonly called steroids have been used to slow the growth of infantile hemangioma. This classification of medication is administered by injection, orally and sometimes topically. Common brand names for orally administered steroids are Prednisone, Prelone, and Prednislone. Oral stereoids are given in single daily dose or two doses spilt up through the day. The dose generally ranges from 2.0mg/kg of body weight to 4.0mg/kg of body weight daily. Rarely is a high dose used. Responce is typically seen in 2-4 weeks, in about 85% of the patients. Once the growth of the hemangioma has slowed or stopped the medication is often slowly tapered down but the duration of the treatment varies in patients. If the taper is done too quickly there can be new growth. Some doctors will use an alternate day dosing during the taper. An alternating daily dose may also help mimize the effects that the steroid has on the adrenal system, reducing complications. Oral Steroids are known to be most effective in treating hemagnioma when initiated during the growth phase of the hemangioma- during the first 6 months. The side effects of steroids are well known. During the time a child is on a steroid medication the managing physician will want to monitor the child for the side effects. It may be necessary for the patient to be seen by the physician every 10-14 days. The physician will be looking for:
A rounded appearance to the face and body: “Cushnoid” appearance.
Problems with heart and lungs
- Elevation in blood pressure
- Increase in blood glucose or glucose in the urine.
While using steroid medications the immune system is weakened. It is important to reduce the exposure to virus and infections during treatment. NO Live Virus immunizations should be given while using steroid medications and until the patient has been off the steroid for at least 1 month. This may mean the immunization schedule needs to be modified. Limit the exposure to other children and adults that could be ill. Everyone should wash their hands more often.
Under no circumstances should the steroid medication be discontinued abruptly or without evaluation from the physician. Oral Steroids should be tapered off slowly.
Chicken Pox Warning: If a patient is exposed to chicken pox virus, notify your physician immediately. Do not delay. Children taking steroid medications should NOT be given the steroid vaccine but all siblings should have either already had the virus or be immunized.
Call your doctor if the person using steroid medications has a fever of 101 degrees F, is lethargic, has a decreased appetite, is sleeping more, shows signs of difficulty breathing, has increased irritability or uncontrolled crying, or is exposed to chicken pox.
May patients taking oral steroids experience stomach discomfort. There are ways to reduce the discomfort:
- There are medications that can be given to decrease the stomach discomfort, and associated reflux. One medication is Zantac. Discuss the use of this medication with your doctor. Never give this medication without consulting your doctor.
- Mix the steroid with formula in a bottle.
- Split the dose of the steroid into 2 equal parts, giving one at night and the other in the morning.
- If there are signs of reflux or vomiting the child may prefer to sleep in an upright position. Many parents use the infant car seat or slightly incline the mattress in the crib.
- * Some physicians will allow rice cereal to be added to the evening bottle to decrease vomiting.
This information was first printed by the National Organization of Vascular Anomalies by a Children’s Miracle Network Grant provided by the Duke University Medical Center, Durham, NC.
NOVA PROVIDES THIS INFORMATION TO FAMILIES AS A RESOURCE. IT IS NOT INTENDED TO ENGAGE IN THE PRACTICE OF MEDICINE OR TO REPLACE THE PHYSICIAN. NOVA DOES NOT CLAIM TO HAVE MEDICAL KNOWLEDGE. NOVA DOES NOT ENDORSE ANY PARTICULAR PHYSICIAN, TREATING FACILITY OR TREATMENT PROTOCAL. IN ALL CASES NOVA AND ITS BOARD OF DIRECTORS RECOMMENDS THAT YOU SEEK THE OPINION OF A PHYSICIAN EXPERIENCED IN THE MANAGEMENT OF HEMANGIOMAS AND VASCULAR MALFORMATIONS.