Bleomycin is a chemotherapeutic agent that inhibits DNA synthesis in cells and viruses. 9 It causes acute tissue necrosis that may stimulate an immune response. 10 There is no consistent evidence regarding the effectiveness of bleomycin for nongenital cutaneous warts. In five RCTs, cure rates ranged from 16 to 94 percent; one trial even showed higher cure rates in the placebo group. 2 , 7 Adverse effects of bleomycin include pain, swelling, and redness for one week after treatment. Necrosis in the skin may cause scarring, pigment change, or nail damage. Because treatment can lead to significant systemic drug exposure, bleomycin should be avoided in children, pregnant women, and patients with peripheral vascular disease or Raynaud disease. 27 Patients are usually referred to a dermatologist for this treatment.
The adverse effects of corticosteroids in pediatric patients are similar to those in adults (see ADVERSE REACTIONS ). Like adults, pediatric patients should be carefully observed with frequent measurements of blood pressure, weight, height, intraocular pressure, and clinical evaluation for the presence of infection, psychosocial disturbances, thromboembolism , peptic ulcers, cataracts, and osteoporosis. Pediatric patients who are treated with corticosteroids by any route, including systemically administered corticosteroids, may experience a decrease in their growth velocity. This negative impact of corticosteroids on growth has been observed at low systemic doses and in the absence of laboratory evidence of HPA axis suppression (ie, cosyntropin stimulation and basal cortisol plasma levels). Growth velocity may therefore be a more sensitive indicator of systemic corticosteroid exposure in pediatric patients than some commonly used tests of HPA axis function. The linear growth of pediatric patients treated with corticosteroids should be monitored, and the potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the availability of treatment alternatives. In order to minimize the potential growth effects of corticosteroids, pediatric patients should be titrated to the lowest effective dose.
The most frequent complaints about hemangiomas stem from psychosocial complications. The condition can affect a person's appearance and provoke attention and malicious reactions from others. Particular problems occur if the lip or nose is involved, as distortions can be difficult to treat surgically . The potential for psychological injury develops from school age onward. It is therefore important to consider treatment before school begins if adequate spontaneous improvement has not occurred. Large hemangiomas can leave visible skin changes secondary to severe stretching that results in altered surface texture.