Propranolol as the First-Line Therapy for Infantile Hemangiomas: Preliminary Results of Two Centers
July 2012 | Volume 11 | Issue 7 | Original Article | 808 | Copyright © July 2012
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.
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.
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