The mechanism of steroids is unknown. Steroids appear to affect the growth of hemangiomas and in some cases, can shrink the hemangioma. These drugs can be given by mouth or they can be injected directly into the hemangioma. In general, systemic steroids are more useful for the treatment of segmental hemangiomas and intralesional steroids are more useful for focal hemangiomas. The major advantage of intralesional injections is the reduction in systemic side effects. Prior to propranolol, steroids were given as first-line therapy.
Steroids have many side effects and for this reason, we prefer to limit the child’s exposure to this potentially harmful drug. A child on steroids should be carefully monitored and although there are exceptions, we prefer to limit the child’s exposure to three months of continuous steroid use.
One of the major disadvantages of steroid treatments is rebound growth. A high proportion of lesions will regrow after treatment has been stopped. This usually prompts the physician to restart treatment and this can prolong the term of treatment. Another disadvantage is the rare but potentially dangerous side effect known as Addisonian crisis. Since our bodies make steroid hormones which are necessary for important metabolic functions, the administration of a high dose, for a prolonged period (greater than 21 days), will stop the adrenal glands from manufacturing steroids. In times of stress, these substances are essential for survival. When the child is exposed to stressful situations such as an infection, trauma or fever, the child will not produce these essential substances. This could potentially be fatal. For this reason, any child on steroids or any child who has been on steroids within the last six months, should receive a stress dose and be monitored by a physician.