Adverse effects of propranolol in a fulminant ulcerated infantile hemangioma

Abstract

Infantile hemangiomas (IHs) are the most common tumors of infancy, with a global prevalence estimated at 1% to 10% of infants. Most hemangiomas are small and regress spontaneously without a need for intervention. However, 5% to 10 % of hemangiomas may cause serious complications and require treatment. Herein, we report the case of a two-month-old female infant with a left hemifacial hemangioma, which became severely ulcerated after the introduction of propranolol. We also report a good improvement afterwards due to combined therapy. An ulcerated infantile hemangioma is the most common complication seen in an IH, which may present a therapeutic challenge especially in the case of concurrent hemorrhage or infection. Although numerous studies support its efficacy and reduced side effects. propranolol may worsen the ulceration of an IH, possibly reflecting a reduced blood flow, causing peripheral ischemia. In some cases of IH with complex ulceration, monotherapy with propranolol may be insufficient.

Regimen for accelerated propranolol initial dosing (RAPID)

“…Recent cases in the literature have reported worsening ulceration of infantile hemangiomas after initiation or escalation of propranolol. 18,19 Our secondary analysis of accelerated propranolol initiation dosing in the setting of infantile hemangiomas with active ulcerations or at high risk of ulcerating demonstrated that accelerated initiation of propranolol at the 2 mg/kg/day dose did not demonstrate any increase in the incidence of new or worsening ulceration when compared to the 1 mg/kg/day dose. Additionally, while there was a longer treatment duration for the 1 mg/kg/day group compared to the 2 mg/kg/day group, this difference was not significant.…”