Hemangiomas of the Nasal Tip Treated with Propranolol

Abstract

Background: Infantile hemangioma is the most common tumor of infancy. There are recent reports of the efficacy of propranolol in the treatment of these hemangiomas. Nasal tip hemangiomas pose a particularly sensitive concern aesthetically and functionally. The treatment of nasal tip hemangiomas is controversial. We assessed the effect of propranolol therapy in hemangiomas of the nasal tip. Objectives: To evaluate the response of nasal tip hemangiomas to systemic propranolol. Methods: During 2008-2010 ten infant with nasal tip hemangiomas presented to our tertiary care center. All underwent comprehensive evaluation by a multidisciplinary team and were then treated with oral propranolol at 2 mg/kg/day, with continuous clinical follow-up until age 14-16 months, or in older infants until the proliferative phase resolved. Results: Eight patients demonstrated good clinical improvement. Two patients had partial improvement. One patient discontinued treatment due to wheezing. Three patients had mild sleep disturbance which did not warrant discontinuation of treatment. No rebound was noticed after cessation of treatment. Limitations: Children presented by referral at variable ages. It is possible that routine initiation of propranolol in neonates at the first sign of nasal hemangioma may reduce the required treatment duration or dose. Conclusions: Early treatment of hemangiomas of the nasal tip with propranolol prevents lesion proliferation, reduces lesion volume, and prevents nasal and facial deformation. Propranolol appears to be a safe and effective treatment. Its efficacy and safety profiles, relative to other accepted therapies, suggest that it should be considered as the first-line treatment when intervention is required.

Treatment of Severe Infantile Hemangiomas With Propranolol: An Evaluation of the Efficacy and Effects of Cardiovascular Parameters in 25 Consecutive Patients

“…Hemangiomas involving the nasal, periocular, and labial areas especially require immediate treatment because the lesions in these areas are vulnerable to ulceration and are difficult to completely treat. 10,11 The current treatment modalities for severe IHs include corticosteroids, laser application, and surgical procedures. Each of these approaches has limitations in terms of therapeutic benefit and potential side-effects.…”

Topical Timolol Maleate 0.5% for Infantile Hemangioma: Its Effectiveness Compared to Ultrapotent Topical Corticosteroids - A Single-Center Experience of 278 Cases

“…Likewise, systemic propranolol with a starting dose of 2 mg/kg/day has also been reported as safe and effective in the treatment of IH [14,15] .…”

3D photography is a reliable method of measuring infantile haemangioma volume over time

“…Volume intra-and interrater reliability were excellent with ICC 0.991 (95% CI 0.982, 0.995) and 0.978 (95% CI 0.955, 0.989), respectively. Conclusion: This study demonstrates images taken with the 3D LifeViz™ camera and lesion volume calculated with Dermapix® software is a reliable method for assessing infantile haemangioma volume over time.Infantile haemangiomas are a common benign growth of infancy, occurring in up to 10% of infants [1]. Measurement of these lesions is important in tracking both their natural progression and response to treatment.…”

“…Infantile haemangiomas are a common benign growth of infancy, occurring in up to 10% of infants [1]. Measurement of these lesions is important in tracking both their natural progression and response to treatment.…”