PMC:4134656 / 7785-9409 JSONTXT

{"project":"2_test","denotations":[{"id":"25136206-18535669-58659535","span":{"begin":315,"end":317},"obj":"18535669"},{"id":"25136206-20237346-58659536","span":{"begin":315,"end":319},"obj":"20237346"},{"id":"25136206-11559219-58659537","span":{"begin":538,"end":540},"obj":"11559219"},{"id":"25136206-11559219-58659538","span":{"begin":775,"end":777},"obj":"11559219"},{"id":"25136206-11559219-58659539","span":{"begin":1194,"end":1196},"obj":"11559219"},{"id":"25136206-21692837-58659540","span":{"begin":1621,"end":1623},"obj":"21692837"}],"text":"Systemic corticosteroids (prednisolone) have been the mainstay of treatment for IH, for several decades. The mechanism of action of steroids is not entirely clear, though it is postulated to have an inhibitory effect on the production of vascular endothelial growth factor A (VEGF-A) by stem cells in haemangiomas.[1718] Steroids are most effective in the early proliferative phase. The usual recommended dose is 2-4 mg/kg/day, which should be continued until cessation of growth or shrinkage of haemangioma followed by gradual tapering.[19] Oral steroids at a dose of 2-3 mg/kg/day result in 75% response, \u003e3 mg/kg/day show 94% response but with greater side effects while a lesser dose of \u003c2 mg/kg/day results in poor response and a rebound phenomenon in 70% of the cases.[19] Bennett et al. in their meta-analysis on the efficacy of corticosteroids for IH included 184 children in a 10-case series. Statistical analysis revealed that a mean prednisone dose of 2.9 mg/kg (range, 1-4.5 mg/kg/day) was used over a mean period of 1.8 months (range, 0.5-5.4 months) before the dose was tapered. The overall response rate was 84% (range, 60-100%) and the mean rebound rate was 36% (range, 0-65%).[19] In a recent study on 20 children with IH, the lesions responded to oral prednisolone at a mean dose of 3.1 mg/kg/day given for a mean duration of 9.16 weeks (range, 3-15 weeks). The mean total duration of treatment including the tapering dose used was 29.9 weeks (range, 15-44 weeks). Overall, 90% of the cases showed \u003e25% improvement with no case of rebound phenomenon during their follow up period of 6 months to 1 year.[20]"}