From the Guidelines
Hemangiomas are benign vascular tumors that typically require no treatment, but for problematic cases, oral propranolol is the first-line therapy at a dose of 2-3 mg/kg/day divided into 2-3 doses for 6-12 months, as recommended by the most recent and highest quality study 1.
Key Considerations
- Most hemangiomas follow a natural course of rapid growth during the first year of life (proliferative phase) followed by gradual regression (involution phase) over several years.
- Problematic hemangiomas that cause functional impairment, pain, bleeding, or significant disfigurement require treatment.
- Before starting propranolol, patients should undergo cardiac evaluation and monitoring of blood pressure and heart rate, as suggested by 1 and 1.
Alternative Treatments
- Topical timolol 0.5% gel applied twice daily for superficial lesions.
- Oral corticosteroids (prednisolone 2-3 mg/kg/day).
- Laser therapy.
- Surgical excision in select cases.
Important Reminders
- Parents should be reassured about the benign nature of most hemangiomas and educated about potential complications to watch for, including ulceration, bleeding, or rapid growth.
- Hemangiomas work through abnormal proliferation of endothelial cells and increased expression of vascular growth factors, which explains their rapid growth phase followed by natural regression as these factors diminish over time, as explained in 1.
Key Points for Practice
- Hemangiomas should be treated in the setting of a life-threatening condition, functional impairment, pain, or bleeding, as stated in 1.
- Medical therapy includes oral propranolol, oral corticosteroids, and intralesional steroid injections.
- Delaying elective surgical resection until after infancy allows for involution and better outcomes, as recommended by 1 and 1.
From the Research
Treatment Options for Hemangioma
- Propranolol and corticosteroids are two common treatment options for infantile hemangiomas (IHs) 2, 3, 4, 5.
- Studies have shown that propranolol is more effective than corticosteroids in treating IHs, with a higher response rate and fewer side effects 3, 4, 5.
- A systematic review and meta-analysis found that propranolol had a pooled response rate of 97%, compared to 69% for corticosteroids 3.
- A retrospective comparative study found that propranolol was superior to oral prednisone in inducing more rapid and greater clinical improvement in IHs 4.
- A randomized controlled study found that propranolol had a consistent and rapid therapeutic effect, while a combination of propranolol and prednisolone had a comparable but not higher efficacy than propranolol alone 5.
Comparison of Treatment Outcomes
- Propranolol has been shown to reduce the need for surgical intervention in patients with IHs, with one study finding that patients treated with propranolol required significantly fewer surgical interventions than those treated with corticosteroids 2.
- Prematurity has been identified as a risk factor for increased odds of surgery in patients with IHs, regardless of the treatment modality used 2.
- The use of propranolol has been associated with a lower risk of complications and side effects compared to corticosteroids 3, 4, 5.
Current Management and Treatment
- β-blockers, such as propranolol, have become a mainstay of therapy for IHs due to their relatively low-risk profile and efficacy 6.
- Other treatment modalities, including corticosteroids, imiquimod, vincristine, bleomycin A5, and interferon α, may be used in certain cases, but have a higher risk of side effects and complications 6.
- Laser therapy and surgical excision are also available treatment options, but are typically reserved for more severe or complicated cases 6.