Infantile hemangioma: Efficacy of low‐dose propranolol and of intralesional bleomycin injection for propranolol non‐response

Abstract

Background Infantile hemangioma (IH) is the most common form of benign childhood vascular tumor. Most resolve spontaneously, but treatment is recommended in patients who develop complication. Propranolol is recommended as the first‐line therapy, while the treatment in the case of non‐response to first‐line therapy depends on the clinical experiences of each center. The aim of this study was to investigate the efficacy of low‐dose propranolol in the treatment of IH, and the outcomes of percutaneous intralesional bleomycin injection (IBI) in patients unresponsive to propranolol. Methods Medical records of 104 children diagnosed with IH between June 2014 and June 2017 were reviewed retrospectively. Results Median patient age was 6 months (range, 3–12 months). Forty‐five patients (43.3%) received therapy: 18 (40%) for cosmetic problems and 27 (60%) for lesion‐related complications. The most common complications were hemorrhage (15.6%) and impairment in visual function (15.6%). All of the patients received propranolol 1 mg/kg/day as the first‐line therapy. Response to treatment was excellent in 35 patients, good in four and poor in one, while five patients did not respond to therapy. The five unresponsive patients received percutaneous IBI at 0.3–0.5 mg/kg/dose as second‐line therapy. The response to treatment was excellent in four patients, good in one. Conclusions The majority of IH resolved spontaneously. In the patients who required treatment, low‐dose propranolol was successful in most, and IBI was effective and safe in the remaining five patients who did not respond to propranolol.

Infantile hemangioma

“…Місцеве введення середників для лікування ІГ характеризується точним діапазоном дії, більш високою місцевою концентрацією та меншою частотою системних побічних реакцій. Для місцевого введення використовують блеоміцин та інші антиміотичні середники [10,24] або кортикостероїди (тріамценолон, бетаметазон) [17,51]. Хоча в дослідженнях стосовно введення антиміотичних препаратів для лікування пропранолол-резистентних ІГ показана їх ефективність, проте в немовлят введення цих препаратів є небажаним, що зумовлено їхньою цитотоксичною дією [40].…”