Baselga, Eulalia M.D. Propanolol for the Treatment of Infantile Hemangiomas of Infancy. Pediatric Dermatology. 25(6):674, November/December 2008.
Pediatric Dermatology; Volume 25(6), Nov/Dec 2008, p 674
Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
Resumen
Introduction: Propanolol has been proposed recently for the treatment of hemangiomas in Infancy. We present our experience with five patients with large hemangiomas of the head and neck that were successfully treated with propanolol. In all cases a written consent from the parents was obtained for a compassionate use of propanolol. None of the patients presented bradicardia, hypotension or any significant side effect.
Case reports: The first patient was an 11 month old girl that presented for the first time with a large segmental malar and periocular hemangioma with retrobulbar extension that was compressing and closing the eye. She was given oral Prednisone at 4 mg/kg/day. After 1 week, she was very irritable and there improvement but the hemangioma was still compressing and closing the eye. She was started on propanolol at 1.5 mg/kg/day while tapering her prednisone dose to 2.5 mg/kg/day. After 1 week there was a marked reduction both in the volume and the superficial component which was browner. Steroids were quickly tapered in 3 weeks without rebound and the improvement has plateaued after 1 month of treatment. The second patient was a 3-month-old boy with a superficial telangiectatic segmental frontotemporal hemangioma and a mandibular hemangioma that extended to the neck and anterior chest where it was deep. MRI revealed that the hemangioma extended to the perilaryngeal area protruding into the laryngeal wall. Oral prednisone at 2.5 mg/kg/ day was started. Steroid taper was initiated after 8 weeks. At 5 months any attempt to taper further than 0.5 mg/kg/day was followed by a rebound. He wasn’t tolerating steroid treatment because of irritability. Propanolol was then added at 1.5 mg/kg, with marked decrease in volume. And improvement of the superficial telangiectatic area. Steroids could be stopped after 3 weeks without rebound. The third patient was a 2-month-old girl with a large exophytic deep ulcerated hemangioma at the posterior neck that presented at our clinic already on prednisone at 3 mg/kg/day for 10 days. She was crying most of the day. The prednisone dose was diminished to 2 mg/kg/day. Laser therapy of the ulceration and corticosteroid reduction failed to reepithelize the ulcer. Beca-plermin was then added for the ulcer and propanolol was started at 2 mg/kg/day. After 1 week she was comfortable, the ulcer was smaller, and there was significant volume reduction. We are continuing corticosteroid tapering. The forth patient was a 6-month-old girl with a large superficial and deep ulcerated hemangioma of the right parotid area. She was given prednisone at a dose of 2.5 mg/kg/day, but at day 5 of treatment more ulcers developed. Corticosteroids were stopped and propanolol at 1.5 mg/kd/day was initiated. After 1 week there was a decrease in volume and the superficial component turned to a brownish hue. After 3 weeks the ulcers were healed. The girl however was irritable and had insomnia that the parents attributed to propanolol and after 3 weeks they interrupted therapy and the irritability resolved. The fifth patient was a 2 month old girl with a segmental hemangioma of the frontotemporal segment that was diminishing the palpebral aperture and starting to compress the cornea. Propanolol at 2 mg/ kg/day was initiated. After 2 weeks of treatment there was marked improvement. We do not have further follow up at the time of the abstract.
Conclusions: Propanolol seems very effective and rapid in action in the treatment of hemangioma. The mode of action, optimal dose and treatment duration need to be addressed in larger studies.
REFERENCES
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