1. Home>
2. Specialties>
3. Dermatology>
4. Summary and Comment

Propranolol for Infantile Hemangioma: A Retrospective Study in 71 Children

This largest study to date showed propranolol to be useful for severe or complicated hemangiomas.

Infantile hemangioma (IH) has been treated with propranolol since 2008 (see JW Dermatol Jun 20 2008). To study the efficacy and safety of this beta-blocker, investigators performed a multicenter, retrospective study of 71 patients (56 female; age range 1–45 months). Propranolol was started before age 6 months in 50 infants. Five babies had subglottic hemangioma causing significant airway obstruction, 63 patients had received no prior treatment, 4 had failed to benefit from corticosteroids, and 4 had failed surgical treatment. Patients with PHACES syndrome were excluded.

After cardiologic evaluation, patients received two daily doses of propranolol (2 mg/kg/day, divided twice daily, for a minimum of 12 weeks; mean, 20 weeks). Blood pressure, heart rate, and serum glucose were monitored. Reductions of at least 50% were seen in 8 IHs (11%) at 4 weeks, 24 (34%) at 8 weeks, and 42 (59%) at 16 weeks. Investigators scored photographs taken every 4 weeks. Significant size reductions were seen at 4 weeks, were most marked in the first 10 weeks, and continued to an average reduction of 60% at 20 weeks.

Efficacy was uninfluenced by sex, age at onset, initiation of treatment beyond the proliferative phase, segmental versus nonsegmental morphology, location, or hemangioma depth. Ulcerated IH resolved in 2 weeks in eight affected patients, and stridor and dyspnea resolved within the first few days in five infants with subglottic IH. Adverse events were uncommon. Ten patients (14%) had agitated sleep, causing one patient to discontinue propranolol at 3 weeks. One patient had cyanotic breath-holding spells that continued after propranolol withdrawal. One patient had stridor (not associated with airway IH), which led to treatment withdrawal. There were no significant episodes of hypotension or hypoglycemia.

Comment: The trends seen in this largest report to date of propranolol therapy for infantile hemangioma are fascinating: Propranolol response was unaffected by initiation during the proliferative phase (also see JW Dermatol Jul 8 2011), location, morphology, or depth of IH. The numbers of ulcerated or subglottic IH in this study were small, but results are consistent with other case reports. Sleep disturbances are not uncommon but can often be ameliorated by decreasing the dose, in my experience. Interested readers are directed to JW Dermatol Nov 6 2009 for information on guidelines for the use of propranolol in IH. Results of controlled trials are pending.

— Mary Wu Chang, MD

Published in Journal Watch Dermatology July 8, 2011

Citation(s):

Bagazgoitia L et al. Propranolol for infantile hemangiomas. Pediatr Dermatol 2011 Mar/Apr; 28:108.

• Medline abstract (Free)

Image Gallery