High Injection Pressure During Intralesional Injection of Corticosteroids Into Capillary Hemangiomas

Egbert, James E.

doi:10.1001/archopht.119.5.677

Cited by 83 publications

(60 citation statements)

References 43 publications

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“…[221][222][223] This complication likely results from a combination of high injection pressures (causing retrograde flow of the drug from the eyelid toward the apex of the orbit) and excessive injection volume. 224 However, in several large series of intralesional corticosteroids for periorbital lesions, this complication was not reported. Avoidance of this complication is discussed further in the subsection "Eye and Orbit" under "IHs With Special Anatomic Concerns.…”

Section: Intralesional Corticosteroidsmentioning

confidence: 98%

“…[221][222][223] However, the actual risk is thought to be quite low and is primarily related to high injection pressure. 224,246,247 This complication is discussed in greater detail in the subsection "Eye and Orbit" under "IHs With Special Anatomic Concerns. "…”

Section: Adverse Effects Of Corticosteroid Therapymentioning

confidence: 99%

“…[221][222][223] This complication is thought to result from several factors, including high injection pressures (causing retrograde flow of the drug from the eyelid toward the apex of the orbit), excessive injection volumes, and direct intravascular injection. 224,246,247 Although it has been argued that high pressures can be avoided by using a large-capacity syringe and small bore cannula, 306 studies suggest that even these precautions may be insufficient in preventing embolization. 224 Other reported complications include hypopigmentation, atrophy of subcutaneous fat, and full-thickness eyelid necrosis.…”

Section: Highlights Of This Sectionmentioning

confidence: 99%

“…224,246,247 Although it has been argued that high pressures can be avoided by using a large-capacity syringe and small bore cannula, 306 studies suggest that even these precautions may be insufficient in preventing embolization. 224 Other reported complications include hypopigmentation, atrophy of subcutaneous fat, and full-thickness eyelid necrosis. [307][308][309][310] With improvements in systemic medications and surgical techniques, many now believe that there are better options for the management of periocular IHs.…”

Section: Highlights Of This Sectionmentioning

confidence: 99%

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Diagnosis and Management of Infantile Hemangioma

Darrow¹,

Mancini²,

Nopper³

et al. 2015

Pediatrics

217

290

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Infantile hemangiomas (IHs) are the most common tumors of childhood. Unlike other tumors, they have the unique ability to involute after proliferation, often leading primary care providers to assume they will resolve without intervention or consequence. Unfortunately, a subset of IHs rapidly develop complications, resulting in pain, functional impairment, or permanent disfigurement. As a result, the primary clinician has the task of determining which lesions require early consultation with a specialist. Although several recent reviews have been published, this clinical report is the first based on input from individuals representing the many specialties involved in the treatment of IH. Its purpose is to update the pediatric community regarding recent discoveries in IH pathogenesis, treatment, and clinical associations and to provide a basis for clinical decision-making in the management of IH.

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Section: Intralesional Corticosteroidsmentioning

confidence: 98%

Section: Adverse Effects Of Corticosteroid Therapymentioning

confidence: 99%

Section: Highlights Of This Sectionmentioning

confidence: 99%

Section: Highlights Of This Sectionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis and Management of Infantile Hemangioma

Darrow¹,

Mancini²,

Nopper³

et al. 2015

Pediatrics

217

290

View full text Add to dashboard Cite

show abstract

“…Injections for periocular hemangiomas are usually performed by ophthalmologists, but reports of retinal artery embolization and blindness have resulted in a reduced use of this modality. [59][60][61] The largest published case series of intralesional steroids found that the majority showed a reduction greater than 50% in volume, with the best results occurring in relatively superficial hemangiomas.…”

Section: Treatmentmentioning

confidence: 99%

Infantile hemangiomas: from pathogenesis to clinical features

Rosenblatt¹,

Mathes²,

Rosbe

2012

RRN

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Infantile hemangiomas (IH) are benign vascular tumors consisting of a collection of immature cells, including progenitor stem cells and disorganized blood vessels. They are the most common benign tumors in childhood. Recently, there have been significant, exciting advancements in the understanding of the pathogenesis and treatment of infantile hemangiomas, which are discussed in this review. The decision to initiate treatment for IH is based on many factors, including size and location, functional compromise, psychosocial implications, and risks and benefits of the proposed therapy. For most families of children with hemangiomas, education about the natural history of IH and reassurance are often the only "treatment" required. A minority of patients with large, complex lesions or lesions that cause functional compromise require early intervention. These patients and families benefit from a multidisciplinary approach to care in vascular birthmark centers. Ongoing multi-institutional clinical trials will provide further important data on the efficacy and safety of hemangioma treatments.

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Adverse Effects of Systemic Glucocorticosteroid Therapy in Infants With Hemangiomas

George¹,

Sharma²,

Jacobson³

et al. 2004

Arch Dermatol

130

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To evaluate the short-and long-term adverse effects of systemic glucocorticosteroid (GS) therapy in infants with hemangiomas.Design: Retrospective chart review of infants treated with GSs for hemangiomas during a 3-year period.Setting: Tertiary care children's hospital Patients: Of 141 patients identified with hemangiomas, 22 were treated with GSs.Interventions: Minimum of 1-month GS therapy at a minimum starting dose of 0.5 mg/kg per day.Outcome Measures: Demographic and anthropometric measurements, starting dose and duration of GS therapy, subjective parental concerns, complications related to hemangioma, adjunctive treatment, and morning cortisol levels and/or results of corticotropin stimulation tests. Results:The average starting dose was 2.23 mg/kg per day; average length of therapy was 28.1 weeks. Complaints of irritability, fussiness, or insomnia were identified in 16 patients (73%). Hypertension, defined as 3 or more episodes of systolic blood pressure higher than 105 mm Hg, was observed in 10 patients (45%). Morning cortisol levels were abnormal in 13 (87%) of the 15 patients evaluated. Low-dose corticotropin stimulation test results were abnormal in 2 of the 3 infants tested.Conclusions: While GS therapy for infantile hemangiomas was tolerated well overall, changes in behavior, insomnia, and gastrointestinal symptoms were common parental concerns. Hypertension and hypothalamicpituitary-adrenal axis suppression were observed frequently. Infants undergoing long-term GS treatment of hemangiomas should be monitored carefully for these potential adverse effects.

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High Injection Pressure During Intralesional Injection of Corticosteroids Into Capillary Hemangiomas

Cited by 83 publications

References 43 publications

Diagnosis and Management of Infantile Hemangioma

Diagnosis and Management of Infantile Hemangioma

Infantile hemangiomas: from pathogenesis to clinical features

Adverse Effects of Systemic Glucocorticosteroid Therapy in Infants With Hemangiomas

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