Sherief R Janmohamed
University Hospital Brussel, Belgium
Sherief R Janmohamed has completed his PhD (Infantile Hemangioma Pathogenesis, Evaluation, and Therapy) after graduating in Medicine, Clinical Epidemiology (including courses at Harvard University, Boston, MA, USA), and Health Sciences (specialization Public Health) from the Erasmus University Rotterdam, the Netherlands. Currently he works at the Department of Dermatology of the University Hospital Brussels, Belgium, and is involved in international studies and a Cochrane review. In his short academic career he has already published more than 20 papers including articles in reputed Dermatology journals. He is also author of several book chapters and often speaks at international congresses and has been awarded for his research.
Background: Infantile hemangioma (IH) is the most frequently occurring tumor in childhood. The pathogenesis remains elusive. Currently, alarming IHs are treated with oral propranolol, a β-blocker. Before 2008, oral corticosteroids were used but these showed more side effects. We have evaluated the use of intra-lesional corticosteroids in alarming peri-ocular IHs, and topical timolol (another β-blocker) in non-alarming peri-ocular IHs. Method: Thirty-four patients with alarming peri-ocular IHs were included. Intra-lesional treatment was standardized according to a prospective protocol. There were no complications at all after therapy. A second intra-lesional injection was necessary in five patients. At follow-up, 6 and 12 months after injection, 94% and 91% of the patients, respectively, had regression of the IH. Astigmatism, activity-score and global assessments all had improved after therapy. Twenty patients with small mostly superficial peri-ocular IH were included and treated with timolol 0.5% ophthalmic solution 3-4 times daily. The treatment was effective in all superficial IHs after 1-4 months. A quick direct inhibitory effect on the growth of the IH followed by slower regression was observed. The children had to be treated during the whole proliferative phase. Deep IHs showed no response. Conclusions: Intra-lesional therapy with corticosteroids is very safe in the treatment of alarming peri-ocular IHs. It remains a good and safe alternative when propranolol is not possible. Topical timolol 0.5% ophthalmic solution is safe and effective in small, non-alarming peri-ocular IHs. We recommend that small superficial peri-ocular IHs should be treated in an early proliferative phase.