Propranolol for infantile hemangioma: An evaluation of its efficacy and safety in Iranian infants

Document Type: Original Article

Authors

1 MD, Assistant Professor of Dermatology, Golestan University of Medical Sciences, Gorgan, Iran

2 MD, Professor of Dermatology, Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 MD, Assistant Professor of Pediatric Cardiac Diseases, Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 MD, Associate Professor of Pediatric Cardiac Diseases, Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

5 MD, , Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

6 MD, Assistant of Pathology, Department of Pathology, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Propranolol has been recently indicated to inhibit the rapid growth and involution of infantile hemangioma. In the present study, we investigated the efficacy and safety of propranolol in Iranian infants.
Methods: A total of 30 infants with indications for medical intervention, such as large hemangiomas, wounds with or without secondary infection, or active trauma-induced bleeding, were selected. First, a total concentration of 1 mg/kg/day was orally administered to the infants; the dosage further increased (2-3 mg/kg/day) in case the infants experienced no adverse effects. Following weekly (one month after treatment) and monthly (up to six months) follow-ups, hemangioma activity score (HAS) was calculated to evaluate swelling, color of the lesion, and ulcer size.
Results: In the present study, infants with the mean age of 5.33±3.50 years received therapy. Improvement was observed in the lesions of all patients, characterized by a significant decline in size, change in color, and reduction in ulcer size (P<0.001). No serious adverse effects were recorded, except agitation which was overcome by reducing the drug concentration.
Conclusion: It seems that propranolol can be considered as an efficacious and safe alternative to other pharmaceutical and surgical interventions for infantile hemangiomas in Iranian infants.

Keywords


  1. Maguiness SM, Frieden IJ. Vascular birthmarks: tumors and malformations. In: Schachner LA, Hansen RC, editors. Pediatric dermatology. 4th ed. Philadelphia: Mosby Elsevier; 2011.
  2. Starkey E, Shahidullah H. Propranolol for infantile haemangiomas: a review. Arch Dis Child. 2011; 96(9):890-3.
  3. Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson textbook of pediatrics. 18th ed. Philadelphia: Elsevier Health Sciences; 2007.
  4. Mansouri P, Hejazi S, Ranjbar M, Shakoei S. Propranolol in infantile hemangioma: a review article. J Skin Stem Cell. 2014; 1(2):e22884.
  5. Richter GT, Friedman AB. Hemangiomas and vascular malformations: current theory and management. Int J Pediatr. 2012; 2012:645678.
  6. Awadein A, Fakhry MA. Evaluation of intralesional propranolol for periocular capillary hemangioma. Clin Ophthalmol. 2011; 5:1135-40.
  7.  Bryan BA. Reconsidering the use of propranolol in the treatment of cosmetic infantile hemangiomas. Angiology. 2013; 2013:e101.
  8. Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol. 2009; 26(5):610-4.
  9. de Graaf M, Breur JM, Raphaël MF, Vos M, Breugem CC, Pasmans SG. Adverse effects of propranolol when used in the treatment of hemangiomas: a case series of 28 infants. J Am Acad Dermatol. 2011; 65(2):320-7.
  10. 10.  Holland KE, Frieden IJ, Frommelt PC, Mancini AJ, Wyatt D, Drolet BA. Hypoglycemia in children taking propranolol for the treatment of infantile hemangioma. Arch Dermatol. 2010; 146(7):775-8.
11. Chiller KG, Passaro D, Frieden IJ. Hemangiomas of infancy: clinical characteristics, morphologic subtypes, and their relationship to race, ethnicity, and sex. Arch Dermatol. 2002; 138(12):1567-76.

12. anmohamed SR, de Waard-van der Spek FB, Madern GC, de Laat PC, Hop WCJ, Oranje AP. Scoring the proliferative activity of haemangioma of infancy: the Haemangioma Activity Score (HAS). Clin Exp Dermatol. 2011; 36(7):715-23.

13. Boon LM, MacDonald DM, Mulliken JB. Complications of systemic corticosteroid therapy for problematic hemangioma. Plast Reconstr Surg. 1999; 104(6):1616-23.

14. S Chik KK, Luk CK, Chan HB, Tan HY. Use of propranolol in infantile haemangioma among Chinese children. Hong Kong Med J. 2010; 16(5):341-6.

15. Leaute-Labreze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taieb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008; 358(24):2649-51.

16. Melo JN, Rotter A, Rivitti-Machado MC, Oliveira ZN. Propranolol for treatment of infantile hemangiomas. An Bras Dermatol. 2013; 88(6 Suppl 1):220-3.

17. Storch CH, Hoeger PH. Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action. Br J Dermatol. 2010; 163(2):269-74.

18. Luu M, Frieden IJ. Haemangioma: clinical course, complications and management. Br J Dermatol. 2013; 169(1):20-30.

19. Marqueling AL, Oza V, Frieden IJ, Puttgen KB. Propranolol and infantile hemangiomas four years later: a systematic review. Pediatr Dermatol. 2013; 30(2):182-91.

20. Hong E, Fischer G. Propranolol for recalcitrant ulcerated hemangioma of infancy. Pediatr Dermatol. 2012; 29(1):64-7.

21. Hermans DJ, Bauland CG, Zweegers J, van Beynum IM, van der Vleuten CJ. Propranolol in a case series of 174 patients with complicated infantile haemangioma: indications, safety and future directions. Br J Dermatol. 2013; 168(4):837-43.

22. Izadpanah A, Izadpanah A, Kanevsky J, Belzile E, Schwarz K. Propranolol versus corticosteroids in the treatment of infantile hemangioma: a systematic review and meta-analysis. Plast Reconstr Surg. 2013; 131(3):601-13.

  1. 23.  Zimmermann AP, Wiegand S, Werner JA, Eivazi B. Propranolol therapy for infantile haemangiomas: review of the literature. Int J Pediatr Otorhinolaryngol. 2010; 74(4):338-42.
  2. 24.  Betlloch-Mas I, Martinez-Miravete MT, Lucas-Costa A, Martin de Lara AI, Selva-Otalaurruchi J. Outpatient treatment of infantile hemangiomas with propranolol: a prospective study. Actas Dermosifiliogr. 2012; 103(9):806-15.
25. Hogeling M, Adams S, Wargon O. A randomized controlled trial of propranolol for infantile hemangiomas. Pediatrics. 2011; 128(2):e259-66.

26. Bagazgoitia L, Torrelo A, Gutiérrez JC, Hernández‐Martín Á, Luna P, Gutierrez M, et al. Propranolol for infantile hemangiomas. Pediatr Dermatol. 2011; 28(2):108-14.