Published online August 10, 2009
PEDIATRICS Vol. 124 No. 3 September 2009, pp. e423-e431 (doi:10.1542/peds.2008-3458)

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ARTICLE

Propranolol for Severe Infantile Hemangiomas: Follow-Up Report

Véronique Sans, MD^a, Eric Dumas de la Roque, MD^b, Jérôme Berge, MD^c, Nicolas Grenier, MD^d, Franck Boralevi, MD^a, Juliette Mazereeuw-Hautier, MD^e, Dan Lipsker, MD^f, Elisabeth Dupuis, MD^g, Khaled Ezzedine, MD^h, Pierre Vergnes, MDⁱ, Alain Taïeb, MD^a, Christine Léauté-Labrèze, MD^a

^a National Reference Center for Rare Skin Diseases
^b Departments of Neonatology
ⁱ Surgery, Children's Hospital, Bordeaux, France
^c Departments of Neuroradiology
^d Radiology, Pellegrin Hospital, Bordeaux, France
^e Department of Dermatology, Purpan Hospital, Toulouse, France
^f Department of Dermatology, Strasbourg Hospital, Strasbourg, France
^g Department of Dermatology, Fort de France Hospital, Fort de France, France
^h National Reference Center for Rare Skin Diseases, Saint-André Hospital, Bordeaux, France

OBJECTIVE: Infantile hemangiomas (IHs) are the most-common soft-tissue tumors of infancy. We report the use of propranolol to control the growth phase of IHs.

METHODS: Propranolol was given to 32 children (21 girls; mean age at onset of treatment: 4.2 months) after clinical and ultrasound evaluations. After electrocardiographic and echocardiographic evaluations, propranolol was administered with a starting dose of 2 to 3 mg/kg per day, given in 2 or 3 divided doses. Blood pressure and heart rate were monitored during the first 6 hours of treatment. In the absence of side effects, treatment was continued at home and the child was reevaluated after 10 days of treatment and then every month. Ultrasound measurements were performed after 60 days of treatment.

RESULTS: Immediate effects on color and growth were noted in all cases and were especially dramatic in cases of dyspnea, hemodynamic compromise, or palpebral occlusion. In ulcerated IHs, complete healing occurred in <2 months. Objective clinical and ultrasound evidence of longer-term regression was seen in 2 months. Systemic corticosteroid treatment could be stopped within a few weeks. Treatment was administered for a mean total duration of 6.1 months. Relapses were mild and responded to retreatment. Side effects were limited and mild. One patient discontinued treatment because of wheezing.

CONCLUSION: Propranolol administered orally at 2 to 3 mg/kg per day has a consistent, rapid, therapeutic effect, leading to considerable shortening of the natural course of IHs, with good clinical tolerance.

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Key Words: angiogenesis • β₂-adrenergic receptors • vincristine • corticosteroids • interferon

Abbreviations: IH—infantile hemangioma • VEGF—vascular endothelial growth factor • bFGF—basic fibroblast growth factor

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Accepted Apr 10, 2009.

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