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Editorial |

Hypothalamic-Pituitary-Adrenal Axis Suppression in Systemic Glucocorticoid-Treated Infantile Hemangiomas Putting the Risk Into Context

Robert Sidbury, MD, MPH
Arch Dermatol. 2009;145(3):319-320. doi:10.1001/archdermatol.2008.576.
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Hemangiomas of infancy (IH) are the most common benign tumor of childhood.1 When small and located in nonvital areas, IH may be safely observed; however, approximately 10% to 20% become “problematic” and require intervention (Figure).2 The gold standard therapy is systemic glucocorticoids (GCs).3 Glucocorticoids have the following well-recognized adverse effects in infants4: irritability, gastrointestinal tract upset, appetite change, decreased growth while receiving treatment, fungal skin infection, hirsutism, cushingoid facies, hypertension, pneumocystis pneumonia, and hypothalamic-pituitary-adrenal (HPA) axis suppression, a potentially devastating adverse effect, which in the appropriate clinical setting may lead to adrenal crisis.

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Complications of infantile hemangiomas. *Typically in the setting of large liver hemangiomas and/or multiple cutaneous hemangiomas. †Kasabach-Merritt phenomenon, typically in the setting of proliferative vascular tumors of infancy other than infantile hemangiomas (eg, kaposiform hemangioendothelioma). ‡Typically in the setting of a subglottic hemangioma often with cutaneous involvement in a “beard” distribution.

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