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Francine Blei Lymphatic Research and Biology. Caroline Gooding,David Meyer Ophthalmic Plastic and Reconstructive Surgery.
Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations. Bleomycin sclerotherapy in congenital lymphatic and vascular malformations of head and neck.
Bleomycin plasma spill-over levels in paediatric patients undergoing intralesional injection for the treatment of haemangiomas.
But the variant of 'giant papillaries' is actually very rare (close to 0%) in the general population, while it is a common characteristic (40%) seen in scleroderma!There is a wide range of hand characteristics which discriminates scleroderma from schizophrenia.

Conventional treatment options include oral and intralesional corticosteroids, external beam radiation, laser therapy, interferon alpha-2b and surgical excision. Case 1 A 3-month-old girl was referred to our tertiary eye clinic with a large capillary hemangioma covering her forehead, nose and the left side of her face [Figure 1].
She could only open the left eyelids to a vertical fissure height of 1mm but was able to fix and follow with both eyes.
Treatment was discontinued after nine injections over 10 months since the final result was very satisfactory [Figure 2]. Figure 2: Ten months later, after nine injections of intralesional bleomycin, the left visual axis is completely cleared and all treated areas show marked improvementClick here to view Case 2 A 10-week-old girl was referred to our clinic with a right periocular capillary hemangioma after earlier debulking surgery had not cleared the visual axis. Examination revealed a normal left eye as well as normal anterior and posterior segments on the right with complete mechanical ptosis due to the hemangioma [Figure 3].
The main mechanism of action of bleomycin is DNA cleavage via oxidative damage caused by free radicals which form when its metal binding core is oxidized.[7] Bleomycin also induces apoptosis in rapidly growing cells and has a sclerosing effect on the vascular endothelium which makes it useful in the proliferating phase of vascular neoplasms.

In one study, no spill-over of bleomycin into the bloodstream could be demonstrated after IBIs which could imply that the risk of developing pulmonary fibrosis after IBIs is small. Bleeding, ulceration, cellulitis, eschar formation, hypopigmentation, transient alopecia and flu-like symptoms may also occur.
Lymphangitis, flagellate hyperpigmentation, and Raynaud's phenomenon have been reported but are rare. Based on our experience, we would like to suggest that IBIs also warrant consideration in the treatment of children with eyelid hemangiomas where conventional modalities have been unsuccessful or where treatment with beta-blockers may be contraindicated. This could represent a significant step forward in the management of a condition that can prove very difficult to treat.

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