Is topical propranolol (beta blocker) indicated for all types of infantile hemangiomas?

From the Guidelines

Topical propranolol is not indicated for all types of infantile hemangiomas, but rather for select small, thin, superficial cases, as stated in the clinical practice guideline for the management of infantile hemangiomas 1. When considering treatment for infantile hemangiomas, it's crucial to assess the size, location, and depth of the hemangioma, as well as the potential for complications or functional impairment.

• Key factors that influence the choice of treatment include the hemangioma's growth characteristics, with the most rapid growth occurring between 1 and 3 months of age, and the potential for permanent skin changes or disfigurement.
• According to the guideline, topical timolol, a related beta-blocker, may be used to treat select small, thin, superficial IHs, but there is no mention of topical propranolol as a first-line treatment for all types of infantile hemangiomas 1.
• The preferred treatment for larger, deeper, or complicated hemangiomas is oral propranolol at a dose of 2 to 3 mg/kg per day, as recommended by the clinical practice guideline 1.
• It's essential to evaluate patients for contraindications and monitor them regularly to adjust treatment as needed, ensuring the best possible outcomes in terms of morbidity, mortality, and quality of life.

From the Research

Indications for Topical Propranolol

• Topical propranolol is indicated for the treatment of superficial infantile hemangiomas (IHs) 2, 3, 4.
• The treatment is most effective for small, superficial hemangiomas at risk of cosmetic sequelae, where the cosmetic or symptomatic impact does not warrant oral propranolol treatment 3.
• Topical propranolol may be used as an adjuvant treatment measure during the wait-and-see period for superficial IHs 2.

Efficacy and Safety

• Topical propranolol has been shown to be effective in treating superficial IHs, with a good or excellent response rate of 59% 3.
• The treatment is generally well-tolerated, with minor local reactions reported in 1.3% of patients 3.
• No systemic adverse effects have been reported with topical propranolol 2, 3, 4.

Comparison with Oral Propranolol

• Topical propranolol may be less effective than oral propranolol, but it is safer and has fewer systemic side effects 5, 3.
• Oral propranolol is associated with a higher risk of systemic adverse events, particularly in younger patients 5, 6.

Treatment Outcomes

• Earlier initiation of treatment with topical propranolol (less than 3 months of age) is associated with improved outcomes 3.
• The concentration of propranolol used in topical preparations can range from 0.5% to 5%, and treatment duration can vary from several weeks to several months 3, 4.