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Interventions for infantile haemangiomas of the skin: abridged Cochrane systematic review and GRADE assessments
Author(s) -
Novoa M.,
Baselga E.,
Beltran S.,
Giraldo L.,
Shahbaz A.,
PardoHernandez H.,
ArevaloRodriguez I.
Publication year - 2019
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.17407
Subject(s) - medicine , placebo , relative risk , adverse effect , randomized controlled trial , psychological intervention , meta analysis , confidence interval , medline , cochrane library , pediatrics , anesthesia , alternative medicine , psychiatry , pathology , political science , law
Summary Background Infantile haemangiomas ( IH ) are soft swellings of the skin that occur in 3–10% of infants. When haemangiomas occur in high‐risk areas or when complications develop, active intervention is necessary. Objective To update a Cochrane Review assessing the interventions for the management of IH in children. Methods We searched for randomized controlled trials in CENTRAL , MEDLINE , Embase, LILACS , AMED , Psyc INFO , CINAHL and six trials registers up to February 2017. We included 28 trials (1728 participants) assessing 12 interventions. Results We downgraded evidence from high to moderate/low for issues related to risk of bias and imprecision. Oral propranolol (3 mg kg −1 daily) probably improves clinician‐assessed clearance vs placebo [risk ratio ( RR ) 16·61, 95% confidence interval ( CI ) 4·22–65·34; moderate quality of evidence (QoE)]; we found no evidence of a difference in terms of serious adverse events ( RR 1·05, 95% CI 0·33–3·39; low QoE). We found the chance of reduction of redness may be improved with topical timolol maleate (0·5% gel applied twice daily) when compared with placebo ( RR 8·11, 95% CI 1·09–60·09; low QoE). We found no instances of bradycardia or hypotension for this comparison. Conclusions Our key results indicate that oral propranolol and topical timolol maleate are more beneficial than placebo in terms of clearance or other measures of resolution, or both, without an increase in harm.