The use of propranolol in the management of periocular capillary haemangioma—a systematic review

Abstract

Capillary haemangioma or infantile haemangioma (IH) is the most common congenital vascular tumour in the periocular region. Several treatment modalities have been documented, with variable degree of success. Propranolol has recently been reported to be an effective and safe alternative. The aim of this systematic review is to examine the evidence base for the use of propranolol administered orally in the management of periocular capillary haemangioma, and use this information to guide future research. A systematic review of literature was carried out by two independent reviewers using the search strategies highlighted below. A total of 100 cases of oral propranolol use in periorbital or orbital capillary haemangiomas have been documented in the literature. Of the 85 cases that had details of previous treatment, it was used as first-line treatment in 50 (58.8%). The commonest dose used was 2 mg/kg/day. Adverse events were documented in one-third of cases; in most cases these were minor. Improvement or complete resolution of the lesions occurred in 96% of cases. Recurrence was noted in one-fifth of cases. Propranolol has shown a lot of promise in the therapy of IH and further research in the form of properly designed randomized trials is certainly warranted. Treatment guidelines based on literature available to date is included in this review.

Haemangioma: clinical course, complications and management

“…It seems to be effective in halting growth and diminishing size of haemangiomas not only during the proliferative phase but also, to a lesser extent, once growth has been completed . Studies of propranolol use in ulcerated haemangiomas, periocular haemangiomas, airway haemangiomas and liver haemangiomas support its use in these specific clinical settings …”

“…If visual compromise is detected or suspected, therapy is indicated. Systemic and intralesional corticosteroids, surgical excision and laser have been used in the past, but propranolol has now become a first‐line treatment in this setting . For small superficial haemangiomas of the eyelid without associated visual compromise, topical timolol maleate shows promise as a safe, new treatment based on case series and reports .…”

Effects of systemic propranolol treatment on physical growth of patients with infantile hemangiomas

“…first reported that propranolol was successful in treating IH . Since then, subsequent reports demonstrated involution of problematic hemangiomas treated with systemic propranolol . Propranolol, which is superior to corticosteroids at controlling the growth phase of complicated IH, has gradually taken the place of corticosteroids and become the first‐line therapy for complicated hemangiomas in many centers …”

Cardiac Screening in Infants with Infantile Hemangiomas before Propranolol Treatment

“…The main cardiac side effects of propranolol are severe bradycardia, hypotension, and poor cardiac contractility. These side effects are dose related and are uncommon at the oral dosage used for IH (typically 2 mg/kg/day), with the rare occurrence of symptomatic hypotension or other parameters when measured . The main noncardiac side effects of propranolol treatment are hypoglycemia and bronchospasm in patients with reactive airway disease.…”