Involution of infantile haemangiomas after imiquimod 5% cream

Abstract

Summary Infantile haemangioma is a common childhood condition, which usually resolves spontaneously and is managed expectantly. In a small percentage of complex cases, haemangiomas may be associated with complications such as persistent bleeding, ulceration, feeding difficulties or visual impairment. Active treatment is often necessary in such cases. Current interventions include surgical, laser and immunomodulatory treatments. Imiquimod 5% cream is a novel alternative topical treatment that may have a potential role in management of these patients. We present our experience of imiquimod 5% cream in the treatment of five children with difficult haemangiomas. We discuss its efficacy and some of the side effects that may be encountered, which have not previously been reported. Infantile haemangioma (IH) is a common childhood condition. Although up to 70% of IHs may resolve spontaneously by mid-childhood, residual cosmetic sequelae may affect the child's social integration and acceptance, resulting in psychological distress1 and parental concern. Additional complications such as ulceration, amblyopia, feeding difficulties and subglottic airway obstruction may mean that early intervention is essential in some cases and desirable in many. This case series highlights the potential therapeutic role of imiq- uimod 5% cream in the management of complicated IH. We also describe the side-effects we encountered, some of which have not been previously reported.