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Topical Imiquimod Clears Infantile Hemangioma

MONTREAL — Topical imiquimod 5% cream can dramatically reduce or resolve some infantile hemangiomas and could be a treatment option as early as the newborn phase, Dr. Marc Bourcier said at Dermatology Update 2007.

This early, noninvasive treatment has minimal side effects and is a welcome option for parents whose other alternatives are surgery or no treatment, said Dr. Bourcier, who is a dermatologist in private practice in Moncton, N.B.

Spontaneous resolution is common in this condition, but it can take as long as 7 years.

The treatment of infantile hemangioma with topical imiquimod was first described in the literature in 2004 in 10 patients; 4 achieved complete resolution, and 3 achieved excellent results (J. Am. Acad. Dermatol. 2004;51:639–42).

In addition, there was also one treatment failure, one treatment discontinuation, and one patient lost to follow-up, said Dr. Bourcier.

Since then there have been just a few reports in the literature, but, inspired by this evidence, Dr. Bourcier has treated three patients successfully.

“It's a limited number … but so far they have had quite a dramatic response,” he said. “Compared with the natural evolution of this condition, what I've seen is significantly better than what we normally would expect.”

A clinical study involving 10 pediatric patients treated at Ste-Justine's Hospital in Montreal is expected to be published soon and will provide further data, he added.

Dr. Bourcier said he believes that, even without effecting a complete resolution, topical imiquimod can slow progression of hemangiomas enough to obviate extensive surgery later, if surgery is needed.

He added, however, that superficial lesions are more likely to respond, compared with deeper ones.

“There are some case reports in the literature of improvement in the deeper lesions, but it is felt that the superficial ones are best suited to topical therapy—and these are the ones that show the most because they are such a bright, fiery red,” he said.

“Hidden lesions are not such a concern, but for facial ones I strongly believe you have to do something before the children get to school, when they start to really socialize and become more self-conscious,” he said in an interview.

Dr. Bourcier speaks from personal experience: His daughter, now aged 12 years, was born with a facial hemangioma. He chose surgical therapy for her when she was 4 years old, with excellent results.

“Imiquimod therapy had not been prescribed for this back then, but if it had, I would surely have chosen it,” he commented.

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MONTREAL — Topical imiquimod 5% cream can dramatically reduce or resolve some infantile hemangiomas and could be a treatment option as early as the newborn phase, Dr. Marc Bourcier said at Dermatology Update 2007.

This early, noninvasive treatment has minimal side effects and is a welcome option for parents whose other alternatives are surgery or no treatment, said Dr. Bourcier, who is a dermatologist in private practice in Moncton, N.B.

Spontaneous resolution is common in this condition, but it can take as long as 7 years.

The treatment of infantile hemangioma with topical imiquimod was first described in the literature in 2004 in 10 patients; 4 achieved complete resolution, and 3 achieved excellent results (J. Am. Acad. Dermatol. 2004;51:639–42).

In addition, there was also one treatment failure, one treatment discontinuation, and one patient lost to follow-up, said Dr. Bourcier.

Since then there have been just a few reports in the literature, but, inspired by this evidence, Dr. Bourcier has treated three patients successfully.

“It's a limited number … but so far they have had quite a dramatic response,” he said. “Compared with the natural evolution of this condition, what I've seen is significantly better than what we normally would expect.”

A clinical study involving 10 pediatric patients treated at Ste-Justine's Hospital in Montreal is expected to be published soon and will provide further data, he added.

Dr. Bourcier said he believes that, even without effecting a complete resolution, topical imiquimod can slow progression of hemangiomas enough to obviate extensive surgery later, if surgery is needed.

He added, however, that superficial lesions are more likely to respond, compared with deeper ones.

“There are some case reports in the literature of improvement in the deeper lesions, but it is felt that the superficial ones are best suited to topical therapy—and these are the ones that show the most because they are such a bright, fiery red,” he said.

“Hidden lesions are not such a concern, but for facial ones I strongly believe you have to do something before the children get to school, when they start to really socialize and become more self-conscious,” he said in an interview.

Dr. Bourcier speaks from personal experience: His daughter, now aged 12 years, was born with a facial hemangioma. He chose surgical therapy for her when she was 4 years old, with excellent results.

“Imiquimod therapy had not been prescribed for this back then, but if it had, I would surely have chosen it,” he commented.

MONTREAL — Topical imiquimod 5% cream can dramatically reduce or resolve some infantile hemangiomas and could be a treatment option as early as the newborn phase, Dr. Marc Bourcier said at Dermatology Update 2007.

This early, noninvasive treatment has minimal side effects and is a welcome option for parents whose other alternatives are surgery or no treatment, said Dr. Bourcier, who is a dermatologist in private practice in Moncton, N.B.

Spontaneous resolution is common in this condition, but it can take as long as 7 years.

The treatment of infantile hemangioma with topical imiquimod was first described in the literature in 2004 in 10 patients; 4 achieved complete resolution, and 3 achieved excellent results (J. Am. Acad. Dermatol. 2004;51:639–42).

In addition, there was also one treatment failure, one treatment discontinuation, and one patient lost to follow-up, said Dr. Bourcier.

Since then there have been just a few reports in the literature, but, inspired by this evidence, Dr. Bourcier has treated three patients successfully.

“It's a limited number … but so far they have had quite a dramatic response,” he said. “Compared with the natural evolution of this condition, what I've seen is significantly better than what we normally would expect.”

A clinical study involving 10 pediatric patients treated at Ste-Justine's Hospital in Montreal is expected to be published soon and will provide further data, he added.

Dr. Bourcier said he believes that, even without effecting a complete resolution, topical imiquimod can slow progression of hemangiomas enough to obviate extensive surgery later, if surgery is needed.

He added, however, that superficial lesions are more likely to respond, compared with deeper ones.

“There are some case reports in the literature of improvement in the deeper lesions, but it is felt that the superficial ones are best suited to topical therapy—and these are the ones that show the most because they are such a bright, fiery red,” he said.

“Hidden lesions are not such a concern, but for facial ones I strongly believe you have to do something before the children get to school, when they start to really socialize and become more self-conscious,” he said in an interview.

Dr. Bourcier speaks from personal experience: His daughter, now aged 12 years, was born with a facial hemangioma. He chose surgical therapy for her when she was 4 years old, with excellent results.

“Imiquimod therapy had not been prescribed for this back then, but if it had, I would surely have chosen it,” he commented.

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