Interventions for infantile haemangiomas of the skin

Abstract

Infantile haemangiomas are a type of birthmark. They are soft, raised swellings on the skin, often with a bright-red surface caused by a non-cancerous overgrowth of blood vessels in the skin. The majority of these lesions are uncomplicated and will shrink on their own by age seven; however, some require treatment if they occur in high-risk areas or cause psychological distress. This article summarises the major findings of a Cochrane Review, which aimed to assess the benefits and harms of treatments for haemangiomas of the skin in infants and children, collecting evidence up to February 2017. The review included 28 studies (1728 children), which assessed lasers, beta-blockers, steroids and radiation therapy, among other treatments. When compared with placebo treatment, propranolol taken by mouth at a dose of 3 mg/kg/day is probably more beneficial in terms of complete or almost-complete clearance of swelling and reduction in volume of the haemangioma (moderate-quality evidence). In addition, timolol maleate 0.5%-gel applied topically (to the skin) twice daily may reduce redness when assessed against placebo (low-quality evidence). Short- or long-term serious cardiovascular events were not reported in either group. Likewise, there was no evidence of a difference between propranolol taken by mouth (via a tablet once per day, at a 1.0 mg/kg/dose) and topical timolol maleate (0.5% eye drops applied twice daily) in terms of their effect on reducing haemangioma size by 50% or more (low-quality evidence). Oral propranolol is currently the standard treatment for this condition, and we did not find evidence to contest this treatment in terms of efficacy and safety. High-quality future research should assess the effects of propranolol and timolol maleate, as well as other alternative medications, on outcomes that are important to patients, including adverse-related events (unwanted side effects), parents’/children's opinions of improvement, and cosmetic appearance.