From the Guidelines
Topical propranolol is not indicated for all types of hemangiomas, but rather for small, superficial ones, while oral propranolol is preferred for larger, deeper, or complicated cases. The use of topical propranolol is generally limited to small, thin, superficial hemangiomas where the medication can adequately penetrate the skin to reach the blood vessels 1. For larger, deeper, or complicated hemangiomas, oral propranolol is the preferred first-line treatment at a dose of 2-3 mg/kg/day divided into 2-3 doses for 6-12 months, as recommended by the clinical practice guideline for the management of infantile hemangiomas 1.
Some key points to consider when using topical propranolol include:
- It should be applied 2-3 times daily to clean, dry skin
- Treatment response should be monitored regularly
- It is most effective for thin, superficial hemangiomas
- Its penetration is limited compared to oral administration
For hemangiomas that are ulcerated, rapidly growing, causing functional impairment, or located in critical areas (such as near the eyes, airways, or liver), oral therapy or other interventions are typically necessary rather than topical treatment alone 1. The mechanism of action of propranolol, a nonselective blocker of β-adrenergic receptors, includes vasoconstriction, inhibition of angiogenesis, and downregulation of matrix metalloproteinases and interleukin-6 1.
In terms of safety, common adverse effects of propranolol include sleep disturbance, cold hands and feet, diarrhea, and bronchial hyperreactivity, while rare adverse effects include bradycardia and hypotension, and severe hypoglycemia 1. Precautions that may reduce the risk of hypoglycemia with propranolol therapy include administration of medication after feeding, holding doses when the patient is ill, and avoiding prolonged intervals between feedings 1.
From the Research
Topical Propranolol for Hemangiomas
- Topical propranolol is indicated for the treatment of superficial infantile hemangiomas, as shown in studies 2, 3, 4.
- The efficacy of topical propranolol for superficial hemangiomas has been demonstrated, with response rates ranging from 59% to 90% 2, 3, 4.
- Topical propranolol may be a safer alternative to oral propranolol, with minimal risk of systemic adverse effects 5, 6, 3.
Types of Hemangiomas
- The studies primarily focus on superficial infantile hemangiomas, with limited information on the efficacy of topical propranolol for other types of hemangiomas.
- There is no clear evidence to suggest that topical propranolol is indicated for all types of hemangiomas, such as deep or mixed hemangiomas 2, 5, 3.
Treatment Outcomes
- Topical propranolol has been shown to be effective in reducing the size and color of superficial hemangiomas, with some studies reporting improvement in as little as 2-3 months 2, 4.
- The response to topical propranolol may be influenced by factors such as the age of the patient and the concentration of the propranolol formulation 6, 3.
- Minor local reactions have been reported in some cases, but systemic adverse effects are rare 5, 3.