Wednesday, January 12, 2011

Propranolol Treatment for Infantile Hemangiomas

Updated 3/2017-- all links removed as many are no longer active and it was easier than checking each one.

The Plastic and Reconstructive Surgery Journal article from 2009 (second reference below) spurred Will J. M. Holmes, M.R.C.S and colleagues to write a letter to the journal noting their experience with propranolol in the treatment of infantile hemangiomas.
Holmes cited two articles (references 3 and 4 below) which report the efficacy of of β-blockers in the treatment of hemangioma.
As part of a larger study, we have used propranolol in a total of 15 patients. So far, we have observed signs of rapid involution of hemangioma within the first week of treatment in all patients. The response rate is faster than those we have seen when corticosteroids are used. In addition to stopping the proliferation of hemangiomas, propranolol also causes rapid involution within a short period.
We now offer propranolol as a first-line treatment to all rapidly proliferating hemangiomas with functional deficit and/or disfigurement. We have developed a treatment protocol in conjunction with the cardiologist that involves pretreatment cardiac workup and an in-hospital titration of propranolol up to 1 mg/kg three times per day. So far, we have not needed to increase the dosage to more than 1 mg/kg three times per day.
Their treatment protocol is referenced to the 5th article below.
Related post:  Propranolol for Hemagiomas?  (March 4, 2009)

1.  Propranolol as First-Line Treatment for Infantile Hemangiomas (Letter); Holmes, Will J. M. M.R.C.S.; Mishra, Anuj M.R.C.S.; Gorst, Cath R.G.N., R.S.C.N.; Liew, Se-Hwang F.R.C.S.; Plast & Reconstr Surgery: January 2010 - Volume 125 - Issue 1 - pp 420-421; doi: 10.1097/PRS.0b013e3181c2a731
2.     Classification of Vascular Anomalies and the Comprehensive Treatment of Hemangiomas;  Burns AJ, Navarro JA, Cooner RD.; Plast Reconstr Surg. 2009;124(1 Suppl.):69e–81e.
3.    Propranolol for severe hemangiomas of infancy; Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, et al.;  N Engl J Med. 2008;358:2649–2651. (pdf)
4.      Beta-blocking Agent for Treatment of Infantile Hemangioma; Bigorre M, Van Kien AK, Valette H. . Plast Reconstr Surg. 2009;123:195e–196e.
5.      More on Propranolol for Hemangioma of Infancy; Siegfried EC, Keenan WJ, Al-Jureidini S. . N Engl J Med. 2008;359:2846–2847.
6.       Ulcerated Hemangiomas of Infancy: Risk Factors and Management Strategies; eLiterature Review (John Hopkins Medicine) , Oct 2007, Vol 1, No 4; Bernard A. Cohen, MD, Susan Matra Rabizadeh, MD, MBA, Mark Lebwohl, MD, and Elizabeth Sloand, PhD, CRNP

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