Propranolol in the Treatment of Problematic Infantile Hemangioma: Review of 35 Consecutive Patients from a Vascular Anomalies Clinic

Abstract

Background: Propranolol, a nonselective b-blocker, has been reported as efficient for controlling the growth of complicated infantile hemangiomas (IHs). No uniformly accepted protocol exists regarding the administration of oral propranolol for IH.Objective: We sought to share our experience using propranolol for problematic IH and to evaluate the efficacy of this treatment modality.Methods: A retrospective chart review analysis was performed for 35 consecutive children treated with propranolol as an oral solution on an outpatient basis in our dermatology/vascular anomalies clinic. A protocol was established with the help of our pediatric cardiologists, including pretreatment electrocardiography and echocardiography. Medical photographs taken after 2 months of treatment were rated by two independent evaluators.Results: We treated 31 girls and 4 boys with a median age of 3.5 months. Rapid improvement was reported in the first days of treatment in 34 patients. Mean improvement after 2 months was 61.5%. No serious adverse effects were reported.Conclusion: Propranolol was effective in controlling the proliferative phase of problematic IH. It was well tolerated in our study.Outpatient treatment is possible if parents follow strict guidelines. Propranolol should be a first-line treatment for problematic IH in carefully selected patients.Renseignements de base: Le propranolol, un bê ta-bloquant non sé lectif, s'est ré vé lé efficace pour maîtriser la croissance des hé mangiomes infantiles compliqué s. On ne dispose pas d'un protocole uniformé ment accepté quant à l'administration du propranolol oral contre l'hé mangiome infantile.Objectif: Nous voulions faire part de notre expé rience d'utilisation du propranolol pour traiter les hé mangiomes infantiles problé matiques et é valuer l'efficacité de cette modalité de traitement.Mé thodes: On a exé cuté une analyse ré trospective des dossiers de 35 enfants consé cutifs qui ont é té traité s par une solution orale de propranolol de faç on ambulatoire dans notre clinique de dermatologie/d'anomalies vasculaires. On a é tabli un protocole avec l'aide de nos cardiologues pé diatriques, lequel comprenait notamment un ECG et une é chographie cardiaque avant le traitement. Les photographies mé dicales prises aprè s 2 mois de traitement ont é té é valué es par deux é valuateurs indé pendants.Ré sultats: Nous avons traité 31 filles et 4 garç ons dont l'â ge mé dian é tait de 3,5 mois. On a signalé , chez 34 patients, une amé lioration rapide dè s les premiers jours de traitement. L'amé lioration moyenne aprè s deux mois s'é levait à 61,5 %. Aucun effet indé sirable grave n'a é té signalé .Conclusion: Le propranolol é tait efficace pour maîtriser la phase prolifé rative de l'hé mangiome infantile problé matique. Lors de notre é tude, il a é té bien tolé ré . Le traitement peut ê tre administré de faç on ambulatoire si les parents observent les directives à la lettre. Nous croyons qu'en pré sence d'un hé mangiome infantile problé matique, le traitement par le propranolol doit ê tre admi...

Genitourinary and perineal vascular anomalies in children: A Seattle children's experience

“…However, because of increased ulceration, pain, and bleeding in the genital location, treatment is recommended. After the introduction of propranolol therapy, its use became widespread, lowering the risk of long-term complications from observation or surgery caused by functional impairment and scarring [10]. In our study, 25% fewer patients in Era 2 experienced ulceration compared with those in the Era 1 (p Z 0.213), likely because of early initiation of propranolol therapy.…”

Efficacy and rebound rates in propranolol‐treated subglottic hemangioma: A literature review

“…Forty‐three patients (88%) exhibited resolution of symptoms within 24 hours of propranolol administration. This quick response is consistent with the time course documented for improvement in cutaneous hemangiomas, as well as with the existing literature regarding airway hemangiomas …”

Propranolol and Infantile Hemangiomas Four Years Later: A Systematic Review

“…Price et al reported that 82% (56/68) of patients had at least 75% clearance of their IH(s). Talaat et al reported 75% (60/80) of patients with > 75% clearance and 94% (75/80) with >50% clearance of their IH(s). Bertrand et al reported two studies, one with 100% (12/12) of patients with >50% improvement and another with 97% (34/35) of patients with clearance between 25% and 75% with propranolol .…”