The role of propranolol in the treatment of infantile hemangioma

Abstract

Introduction: Infantile hemangioma (IH) is one of the most common childhood tumors. There are various medical or surgical therapeutic options, all with suboptimal results. Recently, the successful use of propranolol for involution of IH was described. We report the results of a single-center experience with this therapeutic option. Objective: To prospectively assess the efficacy and safety of propranolol in children with infantile hemangioma. Methods:We performed a prospective analysis of clinical data of all patients with IH referred to a pediatric cardiology center for baseline cardiovascular assessment prior to propranolol therapy. Propranolol was given at a starting dose of 1 mg/kg/day and titrated to a target dose of 2---3 mg/kg/day according to clinical response. Efficacy was assessed through a photographbased severity scoring scale. Safety was assessed by collecting data regarding significant side effects. Results: Starting in 2010, 30 patients (15 female) were referred for propranolol treatment of IH, at a median age of six months (1---63 months). The mean target propranolol dose was 2.8 mg/kg/day, with a mean duration of therapy of 12 months. All patients experienced significant reduction of IH size and volume. There were no side effects. Conclusions: In our experience propranolol appears to be a useful and safe treatment option for severe or complicated IH, achieving a rapid and significant reduction in their size. No adverse effects were observed, although until larger clinical trials are completed, potential adverse events should be borne in mind and consultation with local specialists is recommended prior to initiating treatment. PALAVRAS-CHAVE Hemangioma infantil; Propranolol O papel do propranolol no tratamento dos hemangiomas em idade pediátrica ResumoIntrodução: Os hemangiomas são a lesão tumoral cutânea mais frequente em idade pediátrica. Até ao momento todas as opções terapêuticas (tanto médicas como cirúrgicas) têm resultados sub-ótimos. Recentemente, foi descrita a utilização de propranolol para tratamento dos hemangiomas. Relatamos os resultados da nossa experiência com esta opção terapêutica. Objetivo: Avaliação prospetiva da eficácia e segurança de propranolol em crianças com hemangioma infantil. Métodos: Avaliação prospetiva de todos os doentes com hemangioma referenciados para avaliação cardiovascular prévia ao início de terapêutica com propranolol. O propranolol foi administrado numa dose inicial de 1 mg/kg/dia e titulada para uma dose alvo de 2---3 mg/kg/dia, de acordo com a resposta clínica. A eficácia foi avaliada através de uma escala fotográfica. A segurança foi avaliada através da recolha de dados sobre os efeitos secundários significativos. Resultados: Desde 2010, 30 crianças (15 do sexo feminino) com hemangiomas foram referenciados para avaliação cardiovascular prévia ao início de terapêutica beta-bloqueante, com uma idade média de 6 meses (1-63 meses). A dose alvo média atingida foi de 2,8 mg / kg / dia, com uma duração média de tratamento de 12 meses. Em todos os doe...

Ulcerated Scrotal Hemangioma in an 18-Month-Old Male Patient: A Case Report and Review of the Literature

“…Oral propranolol is considered as the first-line treatment for infantile hemangiomas [ 17 , 18 ]. The possible actions of propranolol include vasoconstriction, inhibition of angiogenesis, and induction of apoptosis.…”

“…Thus, it is possible that when propranolol is ineffective, the proliferation stage has passed. Early diagnosis and treatment, ideally within the first six months of life, are crucial [ 17 ].…”

Cranio-facial-cervical and subglottic hemangioma with respiratory symptoms. A therapeutic emergency

“…En los casos indicados, el propranolol se considera la primera línea terapéutica. Este fármaco es un betabloqueante no selectivo que inhibe el crecimiento e induce la regresión de los HI gracias a su efecto vasoconstrictor, disminución de la expresión de factores de crecimiento endotelial vascular y fibroblástico e inducción de la apoptosis 5 . El propranolol ha revolucionado el tratamiento de los HI ya que es un medicamento con pocos efectos secundarios y con un alto índice de respuesta 5,6,10 .…”

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“… 12 Since then, application of propranolol in treating infantile hemangiomas has rapidly spread across the world, and has greatly improved the cosmetic outcomes of hemangiomas. 13 However, an ideal option for all vascular anomalies was not exist.…”