BRIEF REPORT Pediatric Dermatology 1–2, 2014

A Retrospective Study of Propranolol Therapy in 635 Infants with Infantile Hemangioma Abstract: Six hundred thirty-five patients underwent oral propranolol treatment for infantile hemangioma. The efficacy rate was 91.2% and 162 of the patients recovered completely. No significant adverse effects were observed and the overall incidence of adverse effects was 2.1%.

Infantile hemangioma (IH) is a common benign tumor of infancy, with therapeutic intervention required in approximately 10% of patients (1). Propranolol has shown promise in IH treatment, but its efficacy and side effects are not well established because of the small number of individuals with IHs enrolled in previous studies. We performed a retrospective analysis of a large number of individuals with IH to evaluate the efficacy and safety of propranolol in IH treatment. Six hundred thirty-five patients with IH (ages 16 days to 3 yrs, 204 boys, 431 girls) admitted to Hunan Children’s Hospital from December 2009 to March 2012 were enrolled. They were treated with propranolol at 2 mg/kg/day in two divided doses. They were discharged if no cardiovascular or metabolic side effects were observed after 3 or 4 days. They were reevaluated once a month and blinded investiA

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gators evaluated the therapeutic effects on a 4-point scale (2). Average follow-up was 18.6  7.9 months (range 5–32 mos). Efficacy was judged as positive if the lesions regressed more than 26% of their initial size after propranolol therapy. Five hundred fifty patients had a solitary hemangioma, 69 had multiple hemangiomas (2–5 IHs), and 16 had multifocal hemangiomas (five had hepatic hemangiomas). Hemangiomas were associated with ulceration in 25 patients. Only 592 patients continued propranolol treatment, with 12 stopping because of side effects. Most of the hemangiomas stopped growing or decreased in size in the first month of follow-up. Typical clinical images of the patients are shown in Fig. 1. Of 592 patients, efficacy was judged as poor in 52, fair in 151, good in 165, and excellent in 224. Thus the efficacy was 91.2% (540/592). In 25 patients with ulcerations, the ulcerations healed between the first and second month of treatment. Propranolol was administered again in 26 patients because of recurrence of the hemangioma within 1 to 2 months after cessation of propranolol treatment. Re-treatment of propranolol for 3 to 6 months was effective. Only 12 patients (2%) had noticeable side effects; 3 had intractable diarrhea, 4 had hyperkalemia, 2 had bradycardia, and 3 had no weight gain in 2 months. Nevertheless, all symptoms disappeared after the cessation of propranolol treatment. DISCUSSION Propranolol has been suggested as a first-line agent in IH therapy (3). Our study showed that 91.2% of individuals with IH had tumor regression with C

Figure 1. Clinical images of patient 1, a 1-month old girl. (A) Proliferating hemangioma involving the left lower eyelid and infraorbital region. (B) Obvious color change and softening of the infantile hemangioma (IH) were observed 3 days after initiation of propranolol therapy. (C) Visible shrinkage of the IH was observed within 1 month after initiation of propranolol therapy.

DOI: 10.1111/pde.12308

© 2014 Wiley Periodicals, Inc.

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propranolol treatment and that propranolol had poor efficacy in only 8.8% (52/592) of individuals with IH. Potential side effects of propranolol include bradycardia, hypotension, hyperglycemia, rash, gastrointestinal discomfort or reflux, fatigue, and bronchospasm (4). Twelve of the patients treated with propranolol had hyperkalemia and bradycardia, but these symptoms disappeared after propranolol treatment was discontinued. In the remaining patients who continued propranolol treatment, only 2% (12/602) had noticeable side effects, and all of them disappeared after the cessation of propranolol. Propranolol appears to be an effective treatment for IH with good efficacy and no serious side effects. ACKNOWLEDGMENTS This study was supported by funds from the Natural Science Foundation of Hunan (11JJ5054) and the Department of Science and Technology of Hunan (2010FJ6001).

REFERENCES 1. Haggstrom AN, Drolet BA, Baselga E et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr 2007;150:291–294. 2. Achauer BM, Chang CJ, Vander Kam VM. Management of hemangioma of infancy: review of 245 patients. Plast Reconstr Surg 1997;99:1301–1308. 3. Marqueling AL, Oza V, Frieden IJ et al. Propranolol and infantile hemangiomas four years later: a systematic review. Pediatr Dermatol 2013;30:182–191. 4. Buckmiller LM, Munson PD, Dyamenahalli U et al. Propranolol for infantile hemangiomas: early experience at a tertiary vascular anomalies center. Laryngoscope 2010;120:676–681. Yongqi Luo, M.D. Yinghong Zeng, M.D. Bin Zhou, M.D. Jianping Tang, M.D., Ph.D. Department of Dermatology, Hunan Children’s Hospital, Changsha, China Address correspondence to Jianping Tang, M.D., Ph.D., 86 Ziyuan Road, Changsha, Hunan 410007, China, or e-mail: [email protected].

A retrospective study of propranolol therapy in 635 infants with infantile hemangioma.

Six hundred thirty-five patients underwent oral propranolol treatment for infantile hemangioma. The efficacy rate was 91.2% and 162 of the patients re...
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