Treatment of infantile hemangiomas with propranolol

Infantile hemangioma is a vascular tumor and requires treatment in lesions manifested by potentially dangerous symptoms. It is clinically diagnosed as the most common lesion of newborns, with an occurrence rate of between 4 and 10 percent, predominantly in preterm Caucasian women.

The authors of the article published in the April issue of Plastic and Reconstructive Surgery  aimed to objectively validate the aesthetic results after propranolol treatment for infantile hemangioma, and to produce a therapy protocol, including optimal timing for introduction, pretreatment preparation, dosage, frequency of visits, duration, and patient safety. Propranolol, a nonselective beta-blocker with membrane stabilizing activity, causes accelerated involution of infantile hemangioma. Several publications have reported the improved aesthetic appearance after propranolol treatment for infantile hemangioma using only subjective methods, with limited evidence based on validated objective analysis of treatment results.

Several reports showed the effectiveness of propranolol in rapid inhibition of proliferation and promotion of regression of infantile hemangioma, in cases of even large segmental, periorbital, or airway lesions, with a low rate of complications. The proliferation was inhibited by propranolol after less than 48 hours of treatment in 74 percent of patients and was clinically manifested as palpable softening of lesions with color changed from the primary deep red to blue or purple. In the remaining 26 percent of cases, inhibition of proliferation was demonstrated within 2 weeks.34Regression was clinically observed in less than 2 weeks in 55 percent of cases and by 4 weeks in 16 percent, and lesions remained unchanged in 13 percent of patients.

Propranolol is an effective, well-tolerated, and safe first-line treatment for proliferative hemangioma. Therapy should be commenced early, continued with the target dosage of  2 mg/kg/day in three divided doses through the proliferative phase of infantile hemangioma, and stopped gradually.

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