Oral Sirolimus for Infantile Hemangioma: A Series of Six Patients

A minority of patients with infantile hemangioma (IH) are refractory or intolerant to systemic beta-blockers. Adjunctive sirolimus was clinically beneficial in six patients with IH who were refractory or intolerant to beta-blockade and at risk of complications including disfigurement, ulceration, visual obstruction, and/or airway obstruction. Improvements were seen in both cutaneous and extracutaneous IH following the addition of sirolimus to propranolol therapy, with variable use of systemic corticosteroids. Laboratory abnormalities prompted early sirolimus withdrawal in two patients. Concurrent therapies and natural involution are important confounders that limit the ability to attribute improvements solely to sirolimus.