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Beta-Blocker Busts Infantile Hemangiomas

A serendipitous discovery suggests that propranolol holds great promise for treating endangering hemangiomas.

Infantile hemangiomas are the most common tumors of infancy. Most require no treatment, but treatment is needed if visual or airway obstruction or ulceration arises. Oral corticosteroids are first-line therapy for such troublesome hemangiomas; interferon alfa and vincristine are used less often because of toxicity.

These investigators serendipitously discovered that propranolol effectively treated hemangiomas in two infants who received the drug for cardiac complications while on corticosteroid therapy. One index patient was a 1-month-old infant with a rapidly growing segmental facial hemangioma who had ocular complications and tracheal–esophageal deviation despite oral corticosteroid treatment. Increased cardiac output developed, and propranolol was started. Seven days later, the hemangioma was significantly smaller. Prednisolone was discontinued at 4 months of age, and no rebound occurred. At 9 months of age, visual function was restored.

Subsequently, an additional nine infants with severe or disfiguring hemangiomas were treated with propranolol. Two had prior oral corticosteroid therapy; seven did not. Propranolol (2 mg/kg/day) was initiated at 2 to 6 months of age and discontinued at 8 to 14 months of age. All patients responded within 24 hours after propranolol initiation, and the color and thickness of the hemangioma continued to improve. There was no significant rebound growth after propranolol was discontinued.

The authors hypothesize that propranolol (a nonselective beta-blocker) effectively treats infantile hemangioma by causing vasoconstriction; decreasing expression of the genes for vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), which contribute to angiogenesis; and triggering apoptosis of capillary endothelial cells.

Comment: This is very exciting news. Oral corticosteroids have been the mainstay of therapy for problematic infantile hemangiomas for decades. A safer, easier, and more predictable therapy is sorely needed. Propranolol is an enticing agent to consider; compared with corticosteroids, there is no contest in terms of tolerability and side-effect profile. Further study in this area will be highly anticipated.

— Mary Wu Chang, MD

Published in Journal Watch Dermatology June 20, 2008

Citation(s):

Léauté-Labrèze C et al. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008 Jun 12; 358:2649.

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• For more information, see below citation.
  Mary Chang, 29 Jul 2009 3:08 PM EST
  N Engl J Med 2008; 359:2846-2847, Dec 25, 2008. Correspondence