Tratamiento médico de los hemangiomas

Abstract

There are two clearly differentiated attitudes in the treatment of haemangiomas: the expectant attitude and the therapeutic, medical or surgical attitude. The expectant attitude can be appropriate in cases of small haemangiomas, far from areas of possible functional damage, and with a slow rate of growth; however, it must be remembered that after reaching their maximum involution, about 25% of haemangiomas show a significant deformity. Treatment should be applied to those haemangiomas that obstruct the visual axis, the airway, the auditory channel, (with alteration of functions such as vision, breathing, swallowing and urinary or intestinal functions); to those of rapid growth that produce or might produce tissue destruction or significant disfiguration, ulcerated lesions, and lesions with a great cutaneous extension or visceral affection, which can lead to congestive cardiac insufficiency, or haematological alterations. The recommended treatment is systemic corticosteroids, with an initial dose of 2 to 3 mg/kg/day of prednisone or prednisolone, administered once a day in the morning. The most frequent result is that growth is arrested, while a reduction in size is observed in less than half the cases. Intralesional administration of corticosteroids at intervals of between 4 and 8 weeks is an effective treatment that manages to avoid the adverse effects of systemic corticosteroids. Because of its adverse neurological effects, interferon is only recommended for lesions with a vital or severe functional risk that do not respond to corticosteroids. Cytotoxic drugs are another treatment group: intralesional bleomycin, vincristine, cyclophosphamide and pingiangmycin.