Propranolol as the First-Line Therapy for Infantile Hemangiomas: Preliminary Results of Two Centers

July 2012 | Volume 11 | Issue 7 | Original Article | 808 | Copyright © 2012

Abstract

Aim: Despite a mostly self-limiting course, infantile hemangiomas can cause severe functional and/or cosmetic problems. The aim of this study was to determine the efficiency of propranolol treatment on infantile hemangiomas.
Methods: Sixty-seven infantile hemangioma patients were included in propranolol protocol in two institutions from 2009 to 2011. Participants included 36 boys and 31 girls. An associate protocol with radiology and pediatric cardiology was constructed for appropriate patient selection. Patients received a dose of 2 mg/kg/day, and all were admitted for the first 24 hours of therapy.
Results: Sixty-seven patients were included in the study. Mean age at the initiation of therapy was 7 months (1 to 24 months), and eleven patients were older than 12 months of age when propranolol was started. All patients showed improvement with varying responses. No side effects were detected during the treatment.
Conclusion: Previously defined treatments for hemangiomas were efficient, yet had a limited usage because of side effects. Propranolol, with a high efficacy (not as total involution but stabilization and regression) and feasibility deserves to be the first line therapy for infantile hemangiomas even after the proliferation phase.

J Drugs Dermatol. 2012;11(7):808-811.

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INTRODUCTION

Infantile hemangioma is the most common tumor of infancy.1 Most infantile hemangiomas have a self-limiting and wellknown course, with proliferation and involution phases expected to be completed by age 5 in half of the cases.2 Nonetheless, severe functional or cosmetic problems occur in a significant number of patients in this long natural course. Serious adverse effects and limited efficiencies of the former therapies restricted the hemangioma management until the fortunate discovery by Labréze et al. about the effect of propranolol.3 The aim of our paper is to share our experience and observations on this hot topic.

METHODS

Propranolol has been in our practice (Ege University Department of Pediatric Surgery, Izmir, Turkey and Baku Research Institute on Pediatrics, Baku, Azerbaijan) for problematic hemangiomas since December 2009. This study includes data from December 2009 to June 2011 from Ege University and from February 2010 to June 2011 from Baku Research Institute on Pediatrics. An associate protocol with radiology and pediatric cardiology was established. Patients who opted for propranolol treatment were first evaluated by the same radiologists at the two centers; they provided data about the location, size, type, and the blood flow signal patterns of the mass. Lesions were also evaluated as to the presence of arteriovenous shunts to exclude malformations. Abdominal ultrasonography was performed in patients with segmental hemangiomas or patients having numerous (more than five) lesions. Patients were then evaluated by the same pediatric cardiologists. Echocardiography and electrocardiogram were performed in all patients. Ophthalmologists also consulted patients with periocular hemangiomas. Only patients with tumors causing sensorial or functional impairment, severe cosmetic disturbance (ie, large facial hemangiomas) or ulcerations were included, and patients with even mild cardiovascular problems and reactive airway disease were not included in the protocol. Treatment in premature babies was started after reaching a postconceptional age of 40 weeks. No patient was on any concomitant therapy at the initiation of propranolol treatment. Families were informed in detail, and written consent was obtained. A dose of 2 mg/kg/day was given to all patients and all patients were admitted for the first 24 hours of therapy. Baseline heart rate, blood pressure, serum glucose levels were first recorded and monitored one and three hours after each dose, corresponding with peak absorption time and for a late value, respectively. Patients were also kept under close follow-up for bronchospasm, diarrhea, and profuse sweats reported to occur with propranolol therapy. Only tablet formula of 40 mg of propranolol is available in Turkey; therefore medication was given every 12 hours for an easier use and a better compliance. Patients were then evaluated in the first, third, and sixth

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