High-dose oral methylprednisolone therapy in childhood hemangiomas

The authors report their experience with high-close oral methylprednisolone therapy (HDMP) in 15 infants with complicated hemangiomas. The starting do se for methylprednisolone was 30 mg/kg/day for 5 days, then the dose was ta pered gradually every 5 days to 20, 10, 5, 2.5 and finally to 1 mg/ kg/day. Therapy was then stopped and the patients were followed. An initial respon se was evident in 12 patients. Nine out Of 12 responders showed regrowth si gns. After regrowth, 4 cases received prednisolone at doses between 1 to 5 mg/kg/day and 3 patients received a second course with HDMP cls additional corticosteroid therapy. Overall, 9 out of 15 cases were responders; very go od and good responses were obtained in 5, partial response in 4, and therap y failure in 5 cases. One child was not available for evaluation of respons e. A very rapid initial response was observed in subglottic and periocular hemangiomas. Side effects were not serious and resolved after discontinuati on of treat?,lent. Although the number of patients is small in this study o verall response rate with HDMP regimen seems not to be superior to the regi mens that use lower doses (5 mg/kg/day), but it provides a high initial res ponse rate and the duration of therapy is short. Therefore, it may be usefu l for treating hemangiomas that fail to respond with low doses, especially in centers with limited resources where other treatment modalities cannot b e used at the moment.