Use of Oral Propranolol for Treatment of Infantile Hemangiomas: A Case Report

Abstract

Four infants with infantile hemangioma were treated with oral propranolol 2mg/kg in two divided doses. Propranolol was continued upto one and half year of life. Significant improvement was noted in all infants in the first 2 months of therapy with slow and continuous effect throughout the follow up period. No serious complication were observed. We conclude that oral propranolol should be considered as a first-line agent given in the treatment of infantile hemangiomas.

Effect of oral propranolol on periocular Capillary Hemangiomas of Infancy

“…They are not apparent at birth but are characterised by rapid growth between 3 and 12 months of age (proliferation phase) followed by spontaneous regression between 3 and 7 years of age (involution phase). 1,9 Most cases are asymptomatic and do not require any intervention. However, about 10% of hemangiomas are associated with significant morbidity and functional impairment, airway obstruction or ulceration, and require early intervention to prevent scarring and cosmetic disfigurement.…”

“…Corticosteroids, either orally or through intra lesional injection, have been the mainstay of treatment. 1,3,11 However, steroids are only effective during the early proliferative phase between 1 and 4 months of life, and do not play a significant role in tumor regression. 12 A majority of children referred for therapy are older, hence the efficacy of steroids is open to debate.…”

“…3,12 Other pharmacological agents which have been used include vincristine, cyclophosphamide, interferon alpha, laser and surgical excision, all of which are associated with significant adverse effects. 1,2,12 Leaute-Labreze and colleagues first reported the incidental regression of capillary hemangiomas in infants treated with oral propranolol for cardiac and renal problems in 2008. 13 Following their serendipitous discovery, several reports on the efficacy of oral propranolol in systemic capillary hemangiomas such as hepatic, sub glottis, retroperitoneal, meditational and cutaneous hemangiomas have been published.…”

“…Capillary hemangioma involutes spontaneously by 7 years of age in up to 70% of the patients. 1,2 Hence historically management consisted of close observation. However, CHI in the periocular region, especially involving the upper eyelid, can be potentially vision threatening specially in infants where it obscures the visual axis.…”

“…Numerous approaches have been tried in such cases, such as oral or intra-lesional corticosteroids. 1,3 Oral propranolol, a nonselective beta-blocker, is a recent addition in the armamentarium against CHI. 4 Propranolol causes endothelial cell apoptosis, decreased blood flow along with inhibition of angiogenesis thus causing a rapid decrease in size of the lesion.…”