From the Guidelines
Topical propranolol is not indicated for congenital hemangiomas. Congenital hemangiomas are fully formed at birth and follow a different natural history than infantile hemangiomas, with most congenital hemangiomas either rapidly involuting (RICH) or non-involuting (NICH) 1. While oral propranolol has become the first-line treatment for problematic infantile hemangiomas, it has not shown consistent efficacy for congenital hemangiomas. Topical beta-blockers like propranolol or timolol have even less evidence supporting their use in congenital hemangiomas. This difference in treatment response relates to the distinct pathophysiology of congenital hemangiomas, which lack the same beta-adrenergic receptor expression patterns seen in infantile hemangiomas that make them responsive to beta-blockers.
Key characteristics of congenital hemangiomas include:
- Fully formed at birth
- Either rapidly involuting (RICH) or non-involuting (NICH)
- Distinct pathophysiology compared to infantile hemangiomas
- Lack of consistent efficacy with oral propranolol
- Limited evidence for topical beta-blockers like propranolol or timolol
Management of congenital hemangiomas typically involves:
- Observation for those that are involuting naturally
- Surgical intervention reserved for those causing functional impairment or significant cosmetic concerns
- Consultation with a pediatric dermatologist or vascular anomalies specialist to discuss appropriate options 1.
From the Research
Topical Propranolol for Congenital Hemangioma
- Topical propranolol is indicated for the treatment of superficial infantile hemangiomas, as shown in studies 2, 3, 4, 5, 6.
- The efficacy and safety of topical propranolol have been evaluated in several studies, with results indicating that it is a safe and effective treatment option for superficial infantile hemangiomas 2, 4, 5, 6.
- Topical propranolol has been shown to reduce the size, texture, and color of hemangiomas, with response rates ranging from 59% to 90% 2, 3, 4, 5, 6.
- The concentration of propranolol used in topical formulations has varied, ranging from 0.5% to 5% 3, 5, 6.
- Treatment duration has also varied, ranging from two weeks to 16.5 months 5.
- Earlier initiation of treatment (less than 3 months of age) has been associated with improved outcomes 5.
- Minor local reactions have been reported in some patients, but no systemic adverse effects have been observed 2, 3, 5, 6.
Characteristics of Topical Propranolol Formulations
- Topical propranolol formulations have been prepared as creams, ointments, and gels 3, 5, 6.
- The pharmaceutical profiles of these formulations, including propranolol content, pH, and ductility, have been evaluated 3.
- The stability of topical propranolol formulations has been tested, with no substantial changes observed after storage for 3 months 3.
- The in vitro skin permeability of topical propranolol formulations has been assessed, with results indicating that hydrophilic cream and gellan gum formulations permeate the most 3.