Topical propranolol cream in treatment of superficial infantile hemangiomas: a literature review and 4 years of clinical experience

Abstract

The clinical efficacy and safety profile of propranolol 1% cream in treatment of superficial infantile hemangiomas (IHs) were determined in a preliminary randomized group of eight infants. Five boys and three girls, 3 to 12 months old, with an IHs superficial capillary type on the forehead, posterior side of the neck, forearm, abdomen, or posterior side of the trunk were examined at our outpatient clinic between 2011 and 2014. Topical propranolol was applied twice daily for 10 months with clinical evaluation and photographic documentation performed every 1 to 2 months. Size, texture, and color changes were monitored. Therapeutic efficacy was evaluated using the Archauer system: Grade I (bad) reduction in size < 25%, Grade II (medium) reduction between 26% and 50%, Grade III (good) reduction between 51% and 75%, and Grade IV (excellent) reduction > 75%. The majority of hemangiomas treated, 62.5%, achieved Grade IV. A Grade III outcome was noticed in one patient with an IH (12.5%) and Grade II in 25% of patients with IHs on the abdomen. The treatment was well tolerated without side effects, which indicates that topical application of 1% propranolol is a safe, effective, and cheap therapeutic option for treating superficial IHs.

Topical 1% propranolol cream promotes cutaneous wound healing in spontaneously diabetic mice

“…Propranolol is commonly used to treat a host of cardiovascular diseases and has been successfully used against hemangiomas. Topical propranolol is also safe and effective for the treatment of infantile hemangiomas . Oral propranolol is useful for diabetic wound healing .…”

“…Propranolol 1% cream (patent number: CN201310003911.5) and 0% propranolol cream were provided by Guangzhou General Hospital of Guangzhou Military Command. Propranolol 1% cream has been previously demonstrated effective for the treatment of hemangioma . The vehicles used to prepare the propranolol cream included glycerol monostearate (8.5%), stearic acid (8.5%), stearyl alcohol (8.5%), liquid paraffin (11.75%), glycerol (11.75%), and distilled water (50%).…”

“…Propranolol, a nonselective β‐blocker, is used for the treatment of hypertension and a number of other cardiovascular diseases. Recently, topical or oral propranolol has been used to treat infantile hemangioma . Some scholars believe that oral propranolol can promote wound healing, e.g., in pediatric and adult burn patients .…”

Clinical features and treatment results in children with hemangioma

“…They also suggested that the dose of propranolol could be increased to 3 mg/kg and that topical treatment may be an alternative treatment in cases who oral treatment can not be tolerated 22 . Kovacevic et al 25 showed excellent response to topical treatment containing 1% propranolol in 62.5% of patients with superficial infantile hemangioma. All patients had regression after lesions after treatment.…”

Therapie infantiler Hämangiome

“…Die topische Betablocker‐Therapie hat sich hingegen bisher nicht allgemein etablieren können. Einerseits wurden moderate Therapieerfolge bei superfiziellen infantilen Hämangiomen mit Propranolol‐Zubereitungen sowie den in der Augenheilkunde eingesetzten und daher kommerziell erhältlichen Timolol‐Gelen oder ‐Lösungen erzielt . Demgegenüber steht jedoch eine relevante Resorption der Substanzen über die kindliche Haut, so dass systemische Nebenwirkungen auch bei topischer Therapie beobachtet werden.…”