Short-Term Corticosteroids as Adjunct Therapy for Infantile Hemangiomas

Conclusions

• Corticosteroids should not return as chronic first-line therapy for infantile hemangiomas, but they may still have a niche role as a short-term adjunct or rescue treatment.
• Short courses of oral prednisolone may help selected recalcitrant hemangiomas, especially when response to propranolol is slow or incomplete.
• The strongest potential role for short-term steroids appears to be in difficult ulcerated or impending-ulcerated hemangiomas, where they may speed healing when added to low-dose propranolol.
• Combination therapy with propranolol plus a brief steroid course sometimes produced faster early improvement than propranolol alone, although longer-term outcomes were not consistently superior.
• Evidence for combining steroids with propranolol is mixed, with some studies showing benefit, others showing equivalence by later follow-up, and at least one negative study.
• Potent topical steroids may have modest benefit in thin superficial hemangiomas, but topical timolol generally performs better and is preferred.
• Intralesional steroids remain a selective option for small, localized, or anatomically challenging lesions such as lip or periocular hemangiomas.
• Higher-dose propranolol may sometimes worsen ulceration or prolong healing, so lower-dose regimens may be safer in ulcerated lesions.
• Overall, the presentation argues for reconsidering old steroid therapies as adjuncts rather than replacements for beta-blockers, pending better studies.