Ho Nhung T C, Lansang Perla, Pope Elena
Department of Pediatrics, Section of Dermatology, The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Ontario, M5G 1X8, Canada.
J Am Acad Dermatol. 2007 Jan;56(1):63-8. doi: 10.1016/j.jaad.2006.06.011.
Active nonintervention remains the mainstay of therapy for most uncomplicated infantile hemangiomas (IH) because of their expected involution. Topical imiquimod, with its ability to induce the production of interferon, tumor necrosis factor-alpha, and the antiangiogenesis factor tissue inhibitor of matrix metalloproteinase, has been recently reported to be efficacious in the treatment of IH.
We sought to evaluate the efficacy of imiquimod 5% cream in the treatment of noncomplicated IH and possible side effects.
A retrospective chart review analysis was performed in 18 children (16 girls and 2 boys) with a median age of 18 weeks (range: 4-256 weeks). A total of 22 hemangiomas (14 located on head, 3 on genitalia, 2 on trunk, and 3 on extremities) were treated with imiquimod 5% cream. Imiquimod was applied 3 times weekly in 10 patients and 5 times weekly in 8 patients for a mean duration of 17 weeks (7-46 weeks).
All superficial IH improved, and remission was achieved in 4 hemangiomas. There was little improvement in mixed IH with no or minimal change in all deep hemangiomas. One case with ulcerated hemangioma substantially improved with accelerated ulcer healing and hemangioma size reduction. No systemic complication was observed in any of our patients, with irritation and crusting being the most common reactive effects.
The small-sample, retrospective study limits the interpretation of results.
Imiquimod 5% cream may be most effective in superficial IH. There was no significant correlation between response and early onset of treatment for any IH in our small sample study. Pharmacokinetic analysis and placebo-controlled study should follow to ascertain the safety and efficacy of imiquimod 5% cream in the pediatric age group.
由于大多数单纯性婴儿血管瘤（IH）有望自行消退，积极的非干预措施仍是其主要治疗方法。局部应用咪喹莫特，因其能够诱导干扰素、肿瘤坏死因子-α以及抗血管生成因子基质金属蛋白酶组织抑制剂的产生，最近有报道称其在治疗IH方面有效。
我们旨在评估5%咪喹莫特乳膏治疗单纯性IH的疗效及可能的副作用。
对18例儿童（16例女孩和2例男孩）进行回顾性病历分析，中位年龄为18周（范围：4 - 256周）。总共22个血管瘤（14个位于头部，3个位于生殖器，2个位于躯干，3个位于四肢）接受了5%咪喹莫特乳膏治疗。10例患者每周应用咪喹莫特3次，8例患者每周应用5次，平均疗程为17周（7 - 46周）。
所有浅表性IH均有改善，4个血管瘤实现缓解。混合性IH改善不明显，所有深部血管瘤无变化或变化极小。1例溃疡性血管瘤患者病情显著改善，溃疡愈合加速，血管瘤大小缩小。我们的患者均未观察到全身并发症，最常见的反应性效应是刺激和结痂。
小样本回顾性研究限制了结果的解释。
5%咪喹莫特乳膏可能对浅表性IH最有效。在我们的小样本研究中，对于任何类型的IH，反应与治疗早期开始之间无显著相关性。应进行药代动力学分析和安慰剂对照研究，以确定5%咪喹莫特乳膏在儿童年龄组中的安全性和有效性。
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