Imiquimod May Clear Superficial Infantile Hemangiomas

MIAMI BEACH — Topical imiquimod shows promise for clearing superficial hemangiomas in young infants, according to a small study.

Although most superficial hemangiomas involute spontaneously by the time a child reaches age 4 or 5 years, they can leave behind significant scars, atrophic changes, or deformities. Topical imiquimod (Aldara) may be an option to speed up involution and minimize changes to the skin, Brian Berman, M.D., a coauthor of the study (J. Am. Acad. Dermatol. 2004;51:639–42), said at a seminar sponsored by the Skin Disease Education Foundation.

Other treatment options include cryosurgery, radiation, laser therapy, corticosteroids, and interferon. Although imiquimod and interferon are both im-mune response modifiers, imiquimod is applied locally and thus does not carry the same risk of systemic toxicity, said Dr. Berman, professor of dermatology at the University of Miami. Dr. Berman is a consultant for and on the speaker's bureau of 3M, maker of imiquimod.

Dr. Berman and his colleagues enrolled 10 infants aged 3–7 months with superficial hemangiomas. Participants were treated with imiquimod five times a week up to 16 weeks. One child dropped out after 3 weeks because of inflammation that developed at the treatment site; the study results included nine infants.

Follow-up was between 7 and 9 months after cessation of therapy. “Nine children experienced no systemic effects, no recurrences, no scarring,” Dr. Berman said at the seminar. The Skin Disease Education Foundation and this newspaper are wholly owned subsidiaries of Elsevier.

Four participants had complete resolution of their hemangioma, and three others had greater than 75% resolution at 16 weeks. Another participant showed moderate improvement (judged in the 50%-74% range), but was lost to follow-up after 10 weeks.

There was a treatment failure in the only infant who did not have an inflammatory response to treatment. This child may not have responded because of a receptor deficiency or poor compliance, Dr. Berman said.

“The obvious answer is the child did not use the cream, but the child may be part of the small percentage of the population that has deficient or nonfunctioning Toll-like receptor 7.” The receptor is required for imiquimod activity.