Propranolol treatment of infantile hemangioma: clinical and radiologic evaluations

Talaat, Ahmed; Elbasiouny, Mahmoud S.; Elgendy, Doaa Salah; Elwakil, Tarek F.

doi:10.1016/j.jpedsurg.2011.10.058

Cited by 47 publications

(51 citation statements)

References 28 publications

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“…Demographic and baseline characteristics met the expected population profile observed in previous studies 17,24 : patients were predominantly girls (33 of 45; 73%) and had facial IHs (35 of 45; 78%), and most IHs were localized (28 of 45; 62%). The mean largest diameter for the superficial component was 3.88 cm (SD 2.90 cm; range 0.1 to 12.5 cm), and the mean for the deep component was 3.49 cm (SD 3.09 cm; range 0.5 to 14.0 cm).…”

Section: Resultssupporting

confidence: 70%

Efficacy of Propranolol Between 6 and 12 Months of Age in High-Risk Infantile Hemangioma

et al. 2018

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BACKGROUND AND OBJECTIVES:There is no consensus on optimal treatment duration for propranolol in infantile hemangioma (IH). We evaluated the efficacy and safety of oral propranolol solution administered for a minimum of 6 months up to a maximum of 12 months of age in high-risk IH. METHODS:This single-arm, open-label, phase 3 study was conducted in patients aged 35 to 150 days with high-risk IH in 10 hospitals between 2015 and 2017. The study comprised a 6-month initial treatment period (ITP) plus continuation up to 12 months of age if complete success was not achieved, a follow-up, and a retreatment period. Patients received oral propranolol twice daily (3 mg/kg per day). The primary end point was the success rate at the end of the ITP. Furthermore, the persistence of IH response and efficacy of retreatment was evaluated. RESULTS:The success rate after 6 months of treatment was 47%, increasing to 76% at the end of the ITP. Of the patients who achieved success, 68% sustained success for 3 months without treatment, and 24% required retreatment. Of the 8 patients who were retreated, 7 achieved success. Adverse events, reported by 80% of patients, were mild, which were expected in this population or known propranolol side effects. CONCLUSIONS:Oral propranolol administered beyond 6 months and up to 12 months of age meaningfully increases the success rate in high-risk IH. Success was sustained in most patients up to 3 months after stopping treatment. Retreatment was efficacious, and the safety profile satisfactory.abstract

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Section: Resultssupporting

confidence: 70%

Efficacy of Propranolol Between 6 and 12 Months of Age in High-Risk Infantile Hemangioma

et al. 2018

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“…Several studies have used ultrasonography to measure IH thickness, as well as resistivity index, as a measure of blood flow to follow IH regression. 11, 18,19 However, the objectivity and reliability of the resistivity index has been questioned by some authors owing to high variability and dependency on the activity of the patient. 24 The use of IRT in the assessment of IH growth has been scarcely reported since it was first described in 1975 in a heterogeneous population of IHs and vascular malformations.…”

Section: Discussionmentioning

confidence: 99%

Infrared Thermography to Assess Proliferation and Involution of Infantile Hemangiomas

et al. 2014

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IMPORTANCEInfantile hemangiomas (IHs) are common benign tumors of infancy that have the potential to interfere with vital organ function and cause permanent disfigurement. Currently, few objective and validated measures exist to assess IHs.OBJECTIVE To determine the utility of infrared thermography in assessing and monitoring the growth of IHs. DESIGN, SETTING, AND PARTICIPANTSIn a prospective cohort study conducted at an outpatient dermatology clinic of a tertiary care hospital between February 2011 and December 2012, a convenience sample of 42 infants aged 0 to 6 months with an IH were enrolled. The mean age of the study group was 3.7 months, with the majority of IHs being mixed type (57%) affecting the head and neck (81%). Of the infants, 36 (86%) were receiving active treatment during the study period, and patients were followed for a minimum of 3 clinical visits, at least 1 month apart. MAIN OUTCOMES AND MEASURESAbility of infrared thermography to assess the proliferation and involution of IHs compared with a visual analog scale. Secondary outcomes were reliability, ease of use, and parental acceptance of the instrument. RESULTSThe mean temperature difference at baseline was 1.9°F (95% CI, 1.2°F to 2.7°F), which peaked at 3 months to 2.5°F (95% CI, 0.8°F to 4.2°F), and decreased progressively to 0.2°F (95% CI, −1.1°F to 1.4°F) at 18.5 months (P < .001). This change in temperature was inversely correlated with mean visual analog scale (r = −0.25). Mean temperature differences recorded at baseline and 30 minutes later were not significant (least squares mean baseline temperature, 87.9°F [95% CI, 87.4°F to 88.3°F], vs least squares mean temperature after 30 minutes, 88.1°F [95% CI, 87.7°F to 88.6°F] [P = .14]). Multivariate analysis demonstrated facial location (F 1,365 = 47.63, P < .001), IH type (F 2,365 = 3.26, P = .04), age (F 2,365 = 7.03, P = .001), and surface area at baseline (F 2,365 = 8.18, P < .001) as factors significantly affecting temperature difference over time. Only IH type (Wald χ 2 2 = 6.79, P = .03) and treatment (Wald χ 2 1 = 4.29, P = .04) significantly affected time to reach a zero-temperature difference. All caregivers (100%) reported IRT to be easy to implement, quick to perform, and comfortable for their child.CONCLUSIONS AND RELEVANCE Infrared thermography is a reliable and valid measure of IH growth that is noninvasive, convenient, and well tolerated by infants, making it well suited to daily clinical practice. It has the potential to provide real-time objective results that can be used for routine monitoring and evaluating treatment efficacy.JAMA Dermatol. 2014;150(9):964-969.

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“…[25] Ever since there has been a series of publications describing its therapeutic efficacy and side effects. [262728293031323334353637383940] Currently, it is widely used in IH, particularly for complicated and ulcerated IH, and appears to be the best therapeutic modality. [31]…”

Section: Introductionmentioning

confidence: 99%

“…reported 75% clearance in 75% and >50% clearance in 94% of their 80 cases with IH in 5-8 months (mean 6.53 ± 0.75). [40]…”

Section: Introductionmentioning

confidence: 99%

Management of infantile hemangiomas: Current trends

Sethuraman

Yenamandra

Gupta

2014

J Cutan Aesthet Surg

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Infantile hemangiomas (IH) are common vascular tumours. IH have a characteristic natural course. They proliferate rapidly during the early infantile period followed by a period of gradual regression over several years. Most of the uncomplicated IH undergo spontaneous involution, with a small proportion of cases requiring intervention. These are children with IH in life-threatening locations, local complications like haemorrhage, ulceration and necrosis and functional or cosmetic disfigurements. Systemic corticosteroids have been the first line of treatment for many years. Recently, non-selective beta-blockers, such as oral propranalol and topical timolol, have emerged as promising and safer therapies. Other treatment options include interferon α and vincristine which are reserved for life-threatening haemangiomas that are unresponsive to conventional therapy. This review mainly focuses on the current trends and evidence-based approach in the management of IH.

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Propranolol treatment of infantile hemangioma: clinical and radiologic evaluations

Cited by 47 publications

References 28 publications

Efficacy of Propranolol Between 6 and 12 Months of Age in High-Risk Infantile Hemangioma

Efficacy of Propranolol Between 6 and 12 Months of Age in High-Risk Infantile Hemangioma

Infrared Thermography to Assess Proliferation and Involution of Infantile Hemangiomas

Management of infantile hemangiomas: Current trends

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