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THERAPEUTIC ROUND
Year : 2012  |  Volume : 57  |  Issue : 2  |  Page : 126-127
Variable response to propranolol therapy for infantile hemangiomas


Department of Pediatric Surgery, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India

Date of Web Publication20-Apr-2012

Correspondence Address:
Vishesh Jain
D-9, 2nd Floor, Green Park Extension, New Delhi-110001
India
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Source of Support: Data presented part of project funded by Council of Scientific and Industrial Research, New Delhi, India, Conflict of Interest: None


DOI: 10.4103/0019-5154.94281

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   Abstract 

Since propranolol was accidentally discovered to induce involution of hemangiomas, it is being used by many clinicians with a favourable response. We present our experience with use of propranolol and report three infants with hemangiomas who were treated with propranolol. First infant had a marked involution of the lesion; second infant had a appreciable response while the third infant had a initial minimal response with progressive increase in size of the lesion.


Keywords: Propranolol, infantile hemangiomas, vascular anomaly


How to cite this article:
Jain V, Roychoudhury S, Chadha R, Puri A. Variable response to propranolol therapy for infantile hemangiomas. Indian J Dermatol 2012;57:126-7

How to cite this URL:
Jain V, Roychoudhury S, Chadha R, Puri A. Variable response to propranolol therapy for infantile hemangiomas. Indian J Dermatol [serial online] 2012 [cited 2019 Jun 18];57:126-7. Available from: http://www.e-ijd.org/text.asp?2012/57/2/126/94281



   Introduction Top


We share our experience with three cases of infantile hemangiomas treated by propranolol.

The following protocol for propranolol therapy was followed. All patients underwent thorough clinical examination, complete blood count and blood sugar testing. Oral propranolol was started in a dose of 1 mg/ kg/ day in two divided doses on the first day and, if repeat hemogram and blood sugar were normal, the dose was increased to 2 mg/ kg/day. The children were followed up at 1 week, 2 week, 1 month, and 3 monthly thereafter.


   Case Reports Top


Case 1

A 6-month-old child presented with a huge 10 cm × 8 cm hemangioma of the right parotid region. Propranolol was administered and a marked response was noted within 2 days with near resolution of the lesion in 1 month. Propranalol therapy was continued for a total of 6 months.

Case 2

A 1-month-old child presented with a tense 3 cm × 3 cm hemangioma on the index finger of the right hand. The patient demonstrated an appreciable response to propranolol therapy. The patient has completed 4 months of propranolol therapy.

Case 3

A 1-month-old child presented with an ulcerated 3 cm × 3 cm hemangioma of the upper lip with difficulty in breast feeding. After 10 days of propranalol therapy, there was a minimal decrease in size of the hemangioma with healing of the ulcer [Figure 1]a. Thereafter, the lesion remained static in size until 4 months of treatment were completed. Since then the lesion has gradually been increasing in size despite the dose of propranolol being increased to 3 mg/kg/day [Figure 1]b.
Figure 1: Case 3- a) Ulcerated hemangioma involving the upper lip b) Increase in size of the lesion despite 5 months of propranolol

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   Discussion Top


Infantile hemangioma is the most common childhood tumor. [1] Most hemangiomas regress with age and only approximately 10% will require intervention. [2] Propranolol was discovered serendipitously by Leatue-Labreze et al, to induce accelerated involution of hemangioma. [3] Oral corticosteroids are still considered the first-line therapy for hemangiomas but long- term and high-dosage steroid therapy has numerous side effects. The mechanism of action of propranolol can be attributed to vasoconstriction (early), blocking of proangiogenic signals (intermediate) and induction of apoptosis in proliferating endothelial cells (late). [4] The potential side effects of propranolol are hypoglycemia, hypotension, bradycardia and heart failure of which the most common and worrisome is hypoglycemia.

We did not observe any side effects in any of our patients; however, the experience with propranolol therapy especially with regard to the safety and efficacy in the management of hemangiomas is limited. A few recent studies have demonstrated an excellent efficacy of propranolol without any failure. [5],[6] Our study suggests that although propranolol is safe and effective in the management of most infantile hemangiomas, the response is unpredictable and a few patients may show progression of the disease.

 
   References Top

1.Enjolras O, Mulliken JB. Vascular tumors and vascular malformations (new issues). Adv Dermatol 1997;13:375-423.  Back to cited text no. 1
[PUBMED]    
2.Chang LC, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, et al. Growth characteristics of infantile hemangiomas: Implications for management. Pediatrics 2008;122:360-7.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Leaute-Labreze C, Dumas de la Roque E, Hubiche T, Hubiche T, Boralevi F, Thambo JB, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008;358:2649-51.  Back to cited text no. 3
    
4.Storch CH, Hoeger PH. Propranolol for infantile haemangiomas: Insights into the molecular mechanisms of action. Br J Dermatol 2010;163:269-74.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Holmes WJ, Mishra A, Gorst C, Liew SH. Propranolol as first-line treatment for rapidly proliferating Infantile Haemangiomas. J Plast Reconstr Aesthet Surg 2011;64:445-51.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Manunza F, Syed S, Laguda B, Linward J, Kennedy H, Gholam K, et al. Propranolol for complicated infantile haemangiomas: A case series of 30 infants. Br J Dermatol 2010;162:466-8.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  


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    Abstract
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