Introduction
Capsule Summary
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Ulceration is a common complication of infantile hemangiomas and can be difficult to manage.
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In this study of 20 patients, treatment with propranolol significantly shortened the ulceration time when compared with a group of matched historical controls.
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It is possible that early administration of propranolol in the proliferation phase may prevent ulceration by limiting expansile growth of the hemangioma.
Infantile hemangiomas (IH) occur in approximately 10% to 12% of children younger than 1 year of age. The most common complication is ulceration, possibly affecting 5% to 13% of children with IH.1, 2 Ulceration is nearly always painful, and this leads to problems with eating and sleeping. There may also be bleeding and infection requiring treatment with oral antibiotics. Finally, ulceration heals with scarring, leading to functional problems and cosmetic disfigurement.3, 4, 5, 6 There is no uniform approach to treatment in the literature. In addition to all kinds of wound dressings, topical or oral antibiotics and pain management, treatment with oral corticosteroids, vincristine, interferon, flashlamp pulsed dye laser therapy, and surgical options have been described, often with disappointing results.1, 5, 7
Propranolol was recently introduced as a promising treatment for complicated IH.8 There have been several case-reports of propranolol therapy for ulcerating IH, but no comparative studies have been published.8, 9, 10 In our study, the role of this nonselective beta-blocker was explored by treating 20 patients with an ulcerating IH in the proliferation phase and comparing this patient group with similar historical controls.