Treatment for Infantile Hemangiomas

MacIsaac, Zoe M.; Nayar, Harry S.; Gehris, Robin P.; Mehta, Dhoom Singh; Geisler, Susan; Grunwaldt, Lorelei

doi:10.1097/scs.0000000000002206

Cited by 16 publications

(8 citation statements)

References 18 publications

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“…The majority of growth occurs before 12 weeks, after which growth velocity decreases and usually ceases between 4 and 6 months. Deep IHs appear somewhat later and grow somewhat longer than their superficial counterparts (on average, approximately 1 month more) 3 4 5 . Large, deeply penetrating lesions (particularly in the parotid area) can grow until the patient is 2 years of age 6 but subsequently partially or completely disappear in 30% of patients by 3 years of age, 20% of patients by 5 years, and 30–40% of patients by 9 years; however, these lesions remain unchanged in 10–20% of patients 7 .…”

Section: Discussionmentioning

confidence: 95%

When to stop propranolol for infantile hemangioma

Chang

Zhang

et al. 2017

Sci Rep

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There is no definitive conclusion regarding the optimal timing for terminating propranolol treatment for infantile hemangioma (IH). A total of 149 patients who underwent detailed color Doppler ultrasound examination were included in this study. The characteristics and propranolol treatment of all patients were summarized and analyzed. Patients were divided into two groups according to the lesion regression rate. Among the 149 patients, 38 were assigned to the complete regression group, and 111 were assigned to the partial regression group. The age at which propranolol treatment started, duration of follow-up after treatment discontinuation and rate of adverse events were not significantly different between the two groups. The duration of oral propranolol treatment was shorter in the complete regression group. The age at which propranolol was terminated was younger in the complete regression group, and this group had a lower recurrence rate. Propranolol is safe and effective for the treatment of IHs that require intervention, but it should be stopped at an appropriate time, which is determined primarily by the lesion regression rate after propranolol treatment. Ultrasound is helpful in determining when to stop propranolol for IH.

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Section: Discussionmentioning

confidence: 95%

When to stop propranolol for infantile hemangioma

Chang

Zhang

et al. 2017

Sci Rep

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“…[1] IHs usually manifest during the 1 st month of life and the proliferative phase extends for the first 2 years of age. [2] These hemangiomas may be disfiguring but are not usually life-threatening or function impairing, and most clinicians emphasize an approach of observation before any intervention. Most IHs involute spontaneously in the first decade of life after the 2 nd year.…”

Section: Introductionmentioning

confidence: 99%

Oral propranolol in infantile hemangiomas: Analysis of factors that affect the outcome

Ainipully

Narayanan

Vazhiyodan

et al. 2019

J Indian Assoc Pediatr Surg

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Aim: The primary treatment for the subset of infantile hemangiomas (IHs) which develops complication is pharmacological intervention, and propranolol has become a popular choice. Here, we evaluated the efficacy and safety of propranolol in a clinical cohort of IHs and analyzed clinical characteristics associated with a good outcome. Materials and Methods: We retrospectively reviewed a total of 52 IHs patients, between ages 1 and 48 months (median age: 7.5 months), who were treated with oral propranolol, with dose ranging from 2 to 3 mg/kg/day. Efficacy was evaluated using mean percentage reduction, visual analog scale (VAS), and parental satisfaction levels at week 2 and months 1, 2, 6, and 12. The adverse effects were noted and responses after 6 months were graded. Statistical analyses of the outcome were also performed for the responses with regard to age at propranolol initiation, site of lesion, and mean duration of treatment. Results: A therapeutic response with at least 50% mean percentage reduction in size was noted in 84.6% at the end of 6 months. VAS score and parental satisfaction levels correlated well with mean percentage reduction (63.7 ± 15.6) at 6 months. Patients aged <6 months and those with cephalic lesions exhibited a greater therapeutic response rate with shorter overall mean duration of the treatment. Conclusions: Oral propranolol at 2–3 mg/kg/day dosing has shown to be effective and safe for IHs in pediatric age group. Intervention in the early proliferative phase, with especially, the cephalic lesions result in better resolution rates with shorter duration of overall treatment.

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“…Although propranolol treatment can be efficacious beyond the proliferative phase, irreversible skin changes may have already occurred. In addition, recent studies have demonstrated that early treatment, especially when started during the proliferating phase, has been shown to be associated with better long-term outcomes 12, 13 . Therefore, for the IHs needing treatment, the ideal time to initiate therapy is either before or as soon as the evidence of permanent anatomic distortion or medical sequelae develop.…”

Section: Introductionmentioning

confidence: 99%

Safety and tolerance of propranolol in neonates with severe infantile hemangiomas: a prospective study

Chen

Xiang

et al. 2017

Sci Rep

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Although the efficacy of propranolol for the treatment of infantile hemangiomas (IHs) has been well documented, there is a paucity of clinical data regarding the safety and tolerance of propranolol in neonates. A prospective study of 51 patients less than 30 days of age with severe IH was conducted. All patients were admitted to the hospital for monitoring during initial propranolol treatment at day 0 with dose adjustments at days 7 and 28. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (BG) levels and potential side effects were evaluated during treatment. There were significant decreases in mean heart rate and SBP after the initiation of propranolol therapy (P < 0.05). In contrast, no significant differences in mean DBP and BG levels were observed after each dose during hospitalization (P > 0.05). Bradycardia and hypotension were noted in at least 1 recorded instance in 11.8% and 5.9% of patients, respectively. These hemodynamic changes were not persistent and were asymptomatic. Two patients who had a history of neonatal pneumonia reported severe bronchial hyperreactivity during treatment. This study demonstrated that propranolol administered to properly selected young infants was safe and well tolerated. However, close monitoring should be considered in high-risk young patients.Infantile hemangiomas are the most common vascular tumor in children. If left untreated, the typical characteristic evolution of these tumors is rapid postnatal proliferation, stabilization and slow, spontaneous involution. IHs may be located on any region of the body but are mostly located on the skin of the head, face and neck. Although IHs are usually harmless, approximately 12-24% of IHs have complications. The most commonly occurring complication is ulceration, followed by visual compromise, airway obstruction, auditory canal obstruction and cardiac failure 1 . In many such cases, early intervention may be justified to potentially arrest the growth of the lesion, reduce associated complications, and avoid years of psychosocial concerns.Previously, the standard treatment options for IH included laser, surgical excision or medical therapies such as corticosteroids. The options in life-threatening cases include treatment with vincristine, interferon-α or cyclophosphamide 1 . Unfortunately, none of these therapeutic modalities is ideal due to their restrictions or potentially serious side effects, such as temporary growth retardation, increased risk of infection and behavioral changes 2, 3 . In June 2008, Leaute-Labreze et al. 4 reported their serendipitous discovery that oral propranolol was effective in the management of severe IHs. Subsequently, a growing number of studies further demonstrated that propranolol stops growth and induces an IH regression that is much better and safer than other treatments, including corticosteroids [5][6][7][8][9] . Currently, propranolol has been adopted as a first-line therapy for problematic IHs. Regardless of subtype or depth, the largest increase in ...

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Treatment for Infantile Hemangiomas

Abstract: The authors present a series of patients with IH safely treated with 2 mg/kg/d of propranolol. Using a strict protocol, few complications were observed. Patients achieved significant reduction in size and improvement of the overall appearance of IH.

Cited by 16 publications

References 18 publications

When to stop propranolol for infantile hemangioma

When to stop propranolol for infantile hemangioma

Oral propranolol in infantile hemangiomas: Analysis of factors that affect the outcome

Safety and tolerance of propranolol in neonates with severe infantile hemangiomas: a prospective study

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