Treatment of infantile hemangiomas: therapeutic options in regard to side effects and adverse events – a review of the literature

Abstract

Introduction: While options for treatment strategies for infantile hemangiomas (IH) are numerous, evidence-based information about agents, optimal dosage, adverse effects, treatment modality, pretreatment and treatment strategies remain limited. Areas covered: To evaluate side effects and adverse events of medical treatment in children with infantile hemangioma, a comprehensive review of the literature was performed to provide information for daily practice. In total 254 studies were retrieved from medical databases and comprised 10,022 patients divided into 5 different treatment groups. Information about working mechanism, side effects and adverse events of therapies used as a single agent for IH are discussed and evaluated according to information from pharmacotherapeutic databases. Randomized controlled trials have only scarcely been performed for the many therapeutic options reported for IH. Short-and long-term side effects and adverse events, have not been systematically studied. Subsequently information about the medical treatment options and pharmacotheraputic databases for therapy in children with IH are incomplete. Expert opinion: From the many therapeutic options, propranolol is the first-line approach for IH, predominantly based on clinical observation, efficacy and tolerability in the short-term. The unsolved ravels of possible short and long-term adverse events of propranolol used during early developmental stages of children need thorough review.

Giant Ulcerative Hemangioma in a Newborn

“…Available studies have shown that oral and topical propranolol, topical timolol gel, nadolol and atenolol are highly effective in the treatment of IH. Propranolol it's the most reported beta-blocker used in the treatment of IH [13,14,15,16]. Various dosage schedules have been described for oral propranolol which ranges from 1 to 3 mg/kg/day divided into 3 doses.…”

“…The following adverse events were observed in patients using oral propranolol: mental depression manifested by insomnia, hypoglycemia, hypotension, bradycardia, congestive heart failure, bronchospasm and acrocyanosis. Rebound growth of lesion was noticed after discontinuation of therapy with propranolol [16]. However, compared with other treatment modalities propranolol is a relatively low risk medication [15,16] which makes it the preferred treatment for problematic IH, although that metaanalysis results shows complications rate of medium 31% of patients at a mean dosage of 2.12 mg/kg/day [17].…”

“…The early intervention will facilitate a faster resolution of the IH [16]. Surgery remains an appropriate treatment alternative in IH that are refractory to treatment or that need urgent treatment [14,16].…”

“…The early intervention will facilitate a faster resolution of the IH [16]. Surgery remains an appropriate treatment alternative in IH that are refractory to treatment or that need urgent treatment [14,16]. Even if there are many methods of treatment, evidence-based information about optimal medication and dosage, adverse effects, treatment modality, pretreatment and treatment strategies are still limited.…”

Efficacy and safety of oral atenolol for the treatment of infantile haemangioma: A systematic review

“…More importantly, the lipophilicity of propranolol facilitates its crossing of the blood‐brain barrier, which may induce central nervous system (CNS)‐related side effects, such as sleep disturbance and agitation. Furthermore, patients have experienced intolerable side effects (including sleep disturbance, agitation, bronchial hyperreactivity, bronchospasm and hypoglycaemia), resulting in discontinued use of propranolol and a high risk of recrudescence . Therefore, the search for an alternative therapy with improved efficacy and safety has recently been initiated.…”