From the Guidelines
Propranolol can potentially cause ulceration in infants with congenital hemangiomas, including those on the upper lip, though this is not a common side effect, and the risk is higher for lesions involving the lower lip and perineum, approximately 50%, as opposed to the upper lip 1. When treating infants with propranolol for hemangiomas, typical dosing starts at 1-2 mg/kg/day divided into 2-3 doses, with careful monitoring for side effects, including ulceration, which can be very painful and often result in scarring 1. Some key points to consider when using propranolol for congenital hemangiomas include:
- Ulceration is a common complication, occurring in nearly 16% of patients with IH, most often by 4 months of age, during the rapid growth phase 1
- Ulcerated IH require treatment with propranolol if topical treatment has not been effective or is not appropriate, such as large IH that cannot be treated with topical timolol 1
- Very rarely, propranolol can worsen the ulceration of IH, possibly reflecting reduced blood flow causing peripheral ischaemia, and in such cases, a reduction in the dose of propranolol can be helpful 1
- Treatment with topical timoptol can be a suitable alternative, but this should only be undertaken in specialist settings 1 It is essential to initiate treatment under medical supervision with regular follow-up appointments to monitor both the response of the hemangioma and any potential adverse effects, and to adjust the dose or discontinue treatment if necessary 1.
From the Research
Propranolol and Ulceration in Infants with Congenital Hemangiomas
- Propranolol is a beta-blocker used to treat infantile hemangiomas (IH) and has been shown to be effective in reducing the size and severity of IH [(2,3,4,5)].
- Ulceration is a potential complication of IH, especially when the lesion is located on the upper lip 4.
- Propranolol has been shown to promote healing of ulcerated IH, with complete healing occurring in less than 2 months in some cases 4.
- The safety and efficacy of propranolol in infants with IH have been established, with most studies reporting mild and limited side effects [(2,3,4,5,6)].
Specific Considerations for Upper Lip Lesions
- The location of the IH on the upper lip may increase the risk of ulceration and other complications 4.
- Propranolol may be particularly effective in promoting healing and reducing the risk of complications in infants with upper lip IH 4.
Monitoring and Management
- Close monitoring of infants with IH treated with propranolol is necessary to minimize the risk of adverse effects and ensure optimal treatment outcomes [(2,3,6)].
- Parents and healthcare professionals should be aware of the potential risks and benefits of propranolol treatment and work together to manage the condition effectively [(2,3)].