Copenhagen – Since experts first reported the successful treatment of infantile hemangiomas with oral itraconazole, dermatologists around the world have been asking three questions in unison: Does it really work? Is it safe? What is the mechanism? After the initial results were published (J Dermatol. 2015 Feb;42(2):202-6), expert research quickly followed, providing updated data to answer each of these three key questions at this annual European Academic Dermatology Meeting. Effectiveness: his case series has so far treated 17 children with a mean age of 3.6 months, some of whom had aesthetic or functional effects due to hemangiomas. The specialist reported that treatment was effective in 12 of the 17 children with hemangioma (71%), with 80-100% improvement in lesions, achieving the results expected by the children’s parents and physicians. The therapeutic dose of itraconazole was 5 mg per kg of body weight per day, and the average duration of treatment was 8.8 weeks. Experts treated a child with a secondary Candida albicans infection on the ulcerated surface of hemangioma with itraconazole capsules orally and unexpectedly observed a therapeutic effect of itraconazole on infantile hemangioma. Since itraconazole oral solution is easier for parents to feed their children, he now treats children with hemangioma with oral solution only. Safety: “We monitor liver function before, during and after treatment and all results are in the normal range,” the specialist said. Mild diarrhea occurs in nearly 30 percent of infants while taking the drug, but it resolves gradually and does not need to be discontinued. Treatment mechanism: In vitro laboratory studies by experts have shown that itraconazole inhibits endothelial cell proliferation and angiogenesis in human hemangiomas, while the comparable antifungal drug ketoconazole does not have this effect. In addition, the experts and their team compared itraconazole with propranolol, a first-line treatment for infantile hemangiomas, and found that propranolol required 10 times the drug concentration of itraconazole to achieve the same apoptosis-inducing effect as itraconazole. In further studies, the expert and his team found that itraconazole downregulated two key pathways that affect the growth of hemangiomas: the hedgehog signaling pathway and the PI3K/AKT/mTOR signaling pathway. He said this could be a mechanism for effective treatment.