Infantile Hemangioma Treated With Propranolol
A few pediatricians wrote to us about Dr Robert P. Blereau’s Photoclinic item titled “Deep (Cavernous) Hemangioma” (CONSULTANT FOR PEDIATRICIANS, September 2011, page 326). They wanted to know whether the lesion had been treated with propranolol. This case was a reprinting of an earlier version published in 2004, before propranolol was being used among the general population, which is why the therapy was not mentioned in the case description.
Here, Dr A. M. Margileth of Fernandina Beach, Florida, shares his experience with the use of propranolol in the treatment of an infantile hemangioma.
Dr Margileth writes: “The infant shown was evaluated for a mixed capillary and deep (cavernous) hemangioma of the right eyelid at 6 weeks of age; onset was at 10 days of life. The infant was otherwise healthy. Oral therapy with propranolol was started at about 2 months of age at 1.6 mg/kg/d, given as 1 mL bid or 8 mg daily (Figure). This dosage was increased 6 days later to 1.5 mL bid or 12 mg daily. The dosage was gradually increased to 3 mg/kg daily by age 4 months. Mild insomnia was the only adverse effect. Follow-up revealed normal growth and development at 2.5 years of age. Mild telangiectasia persisted over the T-1 area.
Since 2008, multiple articles have attested to the efficacy and safety of propranolol oral therapy for infantile hemangiomas.1-5 These reports suggest that propranolol is the first and ideal therapy. This is because both the parents and the physician can see a rapid response to therapy within a few days. Nearly 100% response can be expected in infants younger than 6 months who are treated during the proliferative growth phase of infantile hemangioma. Adverse effects, such as bronchospasm, hypoglycemia, hypotension, bradycardia, and hyperkalemia, are reported infrequently.4”
Acknowledgement: Dr Margileth would like to thank John M. DeVaro, MD for referring the patient to him. Dr DeVaro is a pediatric ophthalmologist, Children’s Eye Institute of Savannah in Georgia.