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Response of ulcerated perineal hemangiomas of infancy to becaplermin gel, a recombinant human platelet-derived growth factor
The author set forth to further assess the responsiveness of hemangioma ulceration to 0.01% becaplermin gel and to compare its cost to that of conventional modalities.
The cohort was 8 infants with rapidly growing, ulcerating hemangiomas of the perineum. All of the hemangiomas were at least 6 cm and of superficial or mixed superficial and deep morphology. The infants were treated with becaplermin gel 0.01% and rapid ulcer healing occurred in all patients within 21 days. The average was 10.25 days. The authors concluded that 0.01% becaplermin gel was a safe and effective treatment for perineal hemangiomas with ulceration.
JDD Article Evaluation:
Hemangiomas of infancy are concerning more to the parents than to the physicians. For the most part, hemangiomas "burnout" in several months/years after their rapid growth phase, but when they present in the face they are more worrisome because if they are near the upper airways they may cause obstruction. Ulceration is another complication of ulcers and they are usually hard to treat, especially if they are in their rapid growth phase. The authors present a new therapeutic modality that uses 0.01% becaplermin gel, Regranex[R], is a platelet-derived growth factor designed initially for diabetic foot ulcers but has been used for other types of ulcers. This is an interesting initial study for infantile ulcerating hemangiomas, as when in the growth phase they are hard to treat. Intra-lesional steroids have been used in the past and surgical excision as a last resort. The use of becaplermin gel should be further evaluated in a double-blinded randomized study against more established modalities, like intra-lesional steroids. The rapid healing was promising in establishing this gel into a more established modality.