A Systematic Review of the Efficacy and Safety of Sirolimus (Rapamycin) in the Management of Infantile Hemangioma

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Objective: The use of rapamycin (sirolimus) in the treatment of infantile hemangioma (IH) is a persistent challenge in dermatology. We aim to systematically review the efficacy and safety of rapamycin for IH treatment. Methods: We systematically searched PubMed, Web of Science, and Scopus for relevant English papers up to December 2024. After screening the full texts, eight studies met the inclusion criteria. The quality of the included articles was assessed using the Joanna Briggs Institute checklist. Detailed data about the effectiveness and safety of rapamycin in IH were collected. Findings: A total of 8 articles published between 2013 and 2021 were included, with 8 cases. The ages of the participants ranged from 3 weeks to 10 years. The most common dose of rapamycin used in these papers was 0.8 mg/m2 twice daily, with a range of 0.1 mg/m2 to 2 mg/m2 daily. Most patients had a response to rapamycin therapy (five out of eight patients). Two cases reported gastrointestinal adverse effects, whereas one developed severe, fatal hypoglycemia after angiography, which the authors considered the role that rapamycin in causing this complication to be unlikely. Conclusion: Rapamycin can be a safe and efficient medication in the treatment of IH. Combination therapy, especially in patients resistant to treatment for IH, is a preferred choice for IH treatment and reduces the side effects of propranolol. It is also preferred for the treatment of lesions in the mucosal areas and near important organs.

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