Eighteen cases of soft tissue atrophy after intralesional bleomycin a5 injections for the treatment of infantile hemangiomas: a long-term follow-up

Pediatr Dermatol. 2015 Mar-Apr;32(2):188-91. doi: 10.1111/pde.12422. Epub 2015 Jan 30.


Pingyangmycin is a commonly used drug in China for the treatment of infantile hemangiomas (IHs) and vascular malformations. Also known as bleomycin A5, it has a similar chemical structure to bleomycin. The side effects of bleomycin include swelling, erythema, fever, headache, hyperpigmentation, ulceration, allergic reactions, and pulmonary fibrosis. We conducted this retrospective study to identify the correlation between bleomycin A5 injections and soft tissue atrophy. We performed a retrospective chart review of all patients with IHs who had this treatment and presented with soft tissue atrophy in our department from January 2011 through July 2013. Eighteen children with IHs (14 girls, 4 boys) were included in this study. The average age was 8.6 ± 3.8 years. All of the atrophied deformities were located at the injection site. Thirteen (72.2%) were located on the upper lip, three (16.7%) on the nose, and two (11.1%) on the cheeks. Seventeen (94.5%) received their first injection at the age of 1 or 2 months. The mean number of injections was 3.5 ± 1.6. The mean interval between injections was 1.2 ± 0.3 months. Eight of 18 patients (44.4%) had ulceration after injection. Intralesional bleomycin A5 injection is not safe for the treatment of IHs because it may lead to soft tissue atrophy. Other safer treatments, such as oral propranolol, should replace this treatment.

MeSH terms

  • Atrophy / pathology
  • Bleomycin / administration & dosage
  • Bleomycin / adverse effects
  • Bleomycin / analogs & derivatives*
  • Child
  • Child, Preschool
  • China
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hemangioma, Capillary / diagnosis
  • Hemangioma, Capillary / drug therapy*
  • Humans
  • Injections, Intralesional / adverse effects
  • Male
  • Neoplastic Syndromes, Hereditary / diagnosis
  • Neoplastic Syndromes, Hereditary / drug therapy*
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Skin / drug effects
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / drug therapy*
  • Soft Tissue Injuries / chemically induced*
  • Soft Tissue Injuries / pathology*
  • Time Factors
  • Treatment Outcome


  • Bleomycin
  • bleomycetin

Supplementary concepts

  • Hemangioma, capillary infantile