Original article
Propranolol for treatment of ulcerated infantile hemangiomas

Presented in part at the Journées Dermatologiques de Paris, Paris, Dec 8-12, 2009; and at the 18th International Society for the Study of Vascular Anomalies (ISSVA), Brussels, Belgium, April 21-24, 2010.
https://doi.org/10.1016/j.jaad.2010.12.040Get rights and content

Background

Ulcerated infantile hemangiomas (IH) are a therapeutic challenge. Propranolol, a nonselective beta-blocker, was recently introduced as a novel treatment for IH.

Objective

To evaluate our experience of propranolol in the management of ulcerated IH.

Methods

A national, multicenter, retrospective, observational study was conducted. Data were collected from the medical charts of patients treated from 2008 to 2009 and supplemented by information obtained from parents during targeted telephone interviews.

Results

Thirty-three infants with propranolol-treated ulcerated IH were included. The average time to complete ulceration healing was 4.3 weeks in 30 of 33 patients and was significantly faster for head-and-neck locations (P = .0354). The mean time to complete pain control was 14.5 days. Parents rated treatment as very effective for 27 of 31 patients and very well tolerated for 29 of 31 cases.

Limitations

This was a retrospective uncontrolled study.

Conclusion

Propranolol appears to be an effective and well-tolerated treatment for ulcerated IH.

Introduction

Ulceration is the most common complication of infantile hemangioma (IH). It can result in pain, infection, bleeding, scarring and interfere with sleeping or feeding, all of which may adversely affect the quality of life of the child and its family.

Management of ulcerated IH includes analgesia, wound care, and antibiotics, if required for secondary infection.1, 2 Other treatment modalities include systemic corticosteroids,3 intralesional corticosteroids, flashlamp pulsed-dye laser therapy (FPDL), interferon-alfa, and vincristine. Complete wound healing may take almost 3 months with any treatment regimen.1

Although propranolol is now widely used to treat severe IH,4, 5 it has not been evaluated specifically for ulcerated IH. The objective of this observational study was to describe the therapeutic response, tolerance, and safety of propranolol in a population of infants with ulcerated IH.

Section snippets

Patients and methods

We conducted a national retrospective observational study. All consecutive cases of ulcerated IH evaluated by members of the French “Groupe de Recherche Clinique en Dermatologie Pédia-trique” from Jan 1, 2008 to Sept 1, 2009 were eligible.

Results

Thirty-five patients from 12 centers were identified. One patient was excluded because of lack of follow-up, and another did not meet the inclusion criteria. The remaining 33 cases were included in the analysis.

Discussion

In this retrospective study of 33 children treated with propranolol for ulcerated IH, complete pain control was achieved within a mean time of 14.5 days and at least 30 of 33 ulcers healed within a median time of 4.3 weeks.

Rapid pain control was the most striking effect of propranolol in our study. As recently reviewed by Storch and Hoeger,7 the early therapeutic effect of propranolol on IH may be explained by vasoconstriction. We postulate that pain relief in ulcerated IH is mainly due to this

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Funding sources: None.

Conflicts of interest: None declared.

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