From the Guidelines
The treatment for infantile hemangiomas (IH) should be initiated with oral propranolol at a dose of 2-3 mg/kg/day divided into 2-3 doses for 6-12 months, as it is the first-line treatment for IH that require intervention, as recommended by the American Academy of Pediatrics 1. The decision to treat IH depends on their size, location, and potential complications. Most IH do not require treatment as they typically involute naturally over time. However, for IH that need intervention, oral propranolol is the preferred treatment option.
- The treatment should be initiated under medical supervision with monitoring of heart rate and blood pressure.
- Topical beta-blockers like timolol 0.5% gel or solution applied twice daily can be used for smaller, superficial lesions.
- For IH that don't respond to beta-blockers, systemic corticosteroids (prednisolone 2-3 mg/kg/day) may be considered, though they have more side effects.
- Laser therapy can help with residual telangiectasias or for ulcerated IH.
- Surgery is reserved for specific cases where other treatments have failed or for removing residual tissue after involution. The British Society for Paediatric Dermatology also recommends oral propranolol as the first-line treatment for proliferating IH, with a dose of 2-3 mg/kg/day divided into 2-3 doses for 6-12 months 1.
- The treatment can be stopped at 1 year of age, and the majority of patients with IH do not need treatment beyond 17 months of age.
- It is safe to stop propranolol abruptly (rather than weaning patients off treatment gradually) during or at the end of therapy 1. In cases where propranolol cannot be used or is not effective, corticosteroids are an alternative therapy, with oral prednisolone or prednisone, 2 to 3 mg per kg per day as a single morning dose, often needed for several months 1.
From the Research
Treatment Options for Infantile Hemangiomas
- Propranolol has become the first-line treatment for infantile hemangiomas, replacing corticosteroids, as it has proven to be relatively safe and effective 2, 3.
- The treatment with propranolol shows significant improvement in most hemangiomas relatively rapidly, often within days 2.
- However, propranolol can be associated with adverse events, including sleep disturbances, acrocyanosis, hypotension, bradycardia, respiratory events, and hypoglycemia 2, 4.
- A multidisciplinary approach is crucial for the management of children with complicated infantile hemangiomas, including dermatologists, otolaryngologists, plastic surgeons, hematologists/oncologists, and interventional/diagnostic radiologists 3.
- Indications for intervention include ulceration, prevention of disfigurement, and impairment of function or vital structures 5.
- Congenital hemangiomas are fully formed at birth and differ from infantile hemangiomas in their histological and immunohistochemical findings, representing a distinct clinical entity 5.
- Systemic corticosteroid therapy can be used as an alternative treatment for infantile hemangiomas, especially in cases where propranolol is contraindicated or fails 6.
- Short-course systemic corticosteroid therapy has been shown to be an effective and safe treatment modality for infantile hemangiomas, with a substantially lower cumulative dose of corticosteroids compared to prolonged therapy 6.
Effectiveness of Propranolol
- Propranolol has been shown to be highly effective in the treatment of infantile hemangiomas, with a mean percent improvement in size and extent of 83.8% at 53 weeks after beginning treatment 4.
- The effect of propranolol treatment starts rapidly, within 1 week, and is very promising regardless of patients' and lesions' characteristics 4.
- However, regrowth of infantile hemangiomas after cessation of propranolol has been reported in some cases, highlighting the need for continued treatment until the proliferative phase is considered to stop clinically 4.