Topical propranolol for infantile haemangiomas: a systematic review

Abstract

Infantile haemangiomas are the most common tumour of infancy. Whilst the majority are left untreated to involute spontaneously, residual skin changes commonly occur, particularly in superficial haemangiomas. The current first-line treatment for problematic lesions is oral propranolol; however due to the risk of systemic adverse effects, the use of off-label topical preparations has recently been investigated. Our systematic review was conducted in accordance with PRISMA guidelines. Four databases were searched to identify original articles evaluating the use of topical propranolol as the primary therapy for infantile haemangiomas. Twelve articles with a total of 597 patients and 632 haemangiomas were included. Three topical propranolol preparations were used, creams, ointments and gels and were all prepared by local pharmaceutical laboratories. The concentration of propranolol ranged from 0.5% to 5%. Treatment duration ranged from two weeks to 16.5 months. Overall, 90% of lesions improved following the initiation of topical propranolol. A good or excellent response, defined as a reduction in the size of at least 50%, was seen in 59% of lesions. Earlier initiation of treatment (less than 3 months of age) was associated with improved outcomes. No systemic adverse effects were reported. Minor local reactions were seen in 1.3% of patients. Topical propranolol is safer than oral propranolol, though may be less effective. Topical propranolol may be more suitable for patients with small, superficial haemangiomas at risk of cosmetic sequelae, where the cosmetic or symptomatic impact does not warrant oral propranolol treatment.

Enhanced Percutaneous Delivery of Beta-Blockers Using Thermal Resurfacing Drug Delivery System for Topical Treatment of Infantile Hemangiomas

“…For further details, see the online supplementary material (see www.karger.com/doi/10.1159/000507808) [11][12][13][14][15][16][17][18][19][20] (Table 1).…”

“…Since the discovery of the effect of propranolol on IHs, oral propranolol is considered the first-line treatment for IHs [7]. In light of the possible adverse effects (AEs) profile of the systemic treatment, topical beta-blockers (bBs), namely propranolol hydrochloride and timolol maleate, are widely used for the treatment of superficial IHs [8][9][10], with an improvement in up to 90% of the cases, minor local AEs, and without any reported systemic AEs [11,12]. The use of lasers, microneedles, as well as radio frequency waves, as topical drug delivery systems can en-DOI: 10.1159/000507808 hance bBs bioavailability, and by that augment the response to the treatment; yet, it might be inapplicable in pediatric population due to their low pain tolerance [13].…”

Application of the adenosine triphosphate sensitivity assay in infantile vascular anomalies

“…In 2008, propranolol was serendipitously discovered to cause regression of proliferating hemangiomas in newborns receiving treatment for other disease [8]. Since then, numerous studies have demonstrated the success of propranolol for shrinking hemangiomas through various forms [9]. Although the specific mechanism has not yet been elucidated, propranolol is more effective than other medical intervention of infantile hemangioma with fewer adverse reactions, and so propranolol gradually replaces those therapies with severe injury and high incidence of complications, and gradually becomes the first-line clinical therapy for infantile hemangioma [10].…”

Propranolol Hydrochloride Topical Gel for the Treatment of Infantile Hemangioma

“…The treatment options included in the current treatment strategy of Infantile Hemangioma includes the use of systemic or topical beta-blockers, systemic or intralesional corticosteroids, Interferons, pulsed dye laser therapy, surgical excision etc. The first line agent that is preferred in the treatment of Infantile Hemangioma is propranolol hydrochloride because of its rapid onset of action and good drug tolerability [8]. The orally and intralesionally available therapies are associated with various types of adverse effects, so it is necessary to develop a topical formulation to treat this disease condition.…”