Prolonged growth of infantile hemangioma after pulsed dye laser and oral propranolol treatment

Abstract

Infantile hemangiomas are the most common tumor of childhood and undergo rapid growth during early infancy followed by gradual involution. After involution, residual lesions sometimes remain. Oral propranolol usually induces earlier involution and redness reduction of infantile hemangiomas. However, the optimal treatment duration is unknown and infantile hemangiomas sometimes recur after cessation of treatment. We report three Japanese patients with recurrent infantile hemangiomas on their cheek. These patients were a 1-month-old female baby with a superficial infantile hemangioma, a 3-month-old female baby with a mixed infantile hemangioma and a 4-month-old male baby with a mixed infantile hemangioma. Two of them also received pulsed dye laser treatment. They did not reach complete or nearly complete resolution of infantile hemangiomas at week 25. These patients experienced regrowth of their infantile hemangioma after 20 months of age and took propranolol after the age of 24 months. There were no severe adverse effects. Propranolol may not only be therapeutic but also prophylactic. Patients with infantile hemangiomas who have taken oral propranolol should be followed up at least 6 months after cessation of treatment, especially infantile hemangiomas on the cheek, and those with partial response to propranolol may require close attention in prolonged growth.

Case report: Deterioration of infantile hemangioma related to oral or nebulized administration of β2-AR agonist: Three cases reports

“…Because of the lack of further examinations, there was no direct evidence to definitively determine whether propranolol withdrawal or nebulized salbutamol therapy caused the deterioration in this case. Current reports of IH deterioration after propranolol discontinuation or β2-AR agonist administration suggested that it was not a common occurrence and the interval time varied widely from 1 to 8 months ( 12 , 26 ). A variety of factors can play a role in IH deterioration, and the exact mechanism remains unclear.…”

“…Shinji et al. ( 26 ) reported three cases of IH rebound in 1 month after completing the treatments, in multiple times. Nicole et al.…”

The Role of Systemic and Topical Beta-Blockers in Dermatology: A Systematic Review

“…Ultrasound is helpful in assessing treatment efficacy upon termination by measuring IH thickness and vascularity [ 46 ]. Patients with IH who received oral propranolol should be followed up to at least 6 months [ 47 ].…”

“…Ultrasound is helpful in assessing treatment efficacy upon termination by measuring IH thickness and vascularity [46]. Patients with IH who received oral propranolol should be followed up to at least 6 months [47]. Topical beta-blockers have been proven to be efficacious and safe in treating PG as well, mostly for small, superficial infantile PG and PG-like lesions induced by EGFR-I [22].…”

Infantile Hemangiomas: An Update on Pathogenesis and Treatment

“…The known risk factors of IH recurrence are female sex, tumor size over 50 cm 3 , tumor location on head and neck, deep or mixed type hemangioma, and early treatment withdrawal (<9 months) [37]. Kagami et al suggest that patients with IH should be monitored for up to 6 months after the cessation of treatment [38]. In a follow-up study of the outcomes of propranolol treatment, in a group of 80 patients, lesions were found in 91.2% (73/80).…”