title: [Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations].
abstract: The therapeutic arsenal for hemangiomas in early childhood can now be considered to include oral β-blockers, mainly propranolol. These drugs are thought to act as vasoconstrictors, regulating angiogenic pathways and inducing apoptosis of vascular endothelial cells. Although infantile hemangioma is not among the approved indications for β-blockers, many specialized clinics will prescribe propranolol before resorting to corticosteroids. A dosage of 2 mg/kg/d, is usually employed with a dosing interval of 8 hours. Propranolol is safe, causing few side effects, although cases of hypoglycemia, hypotension, diarrhea, reflux, cold hands and feet, bronchospasm, and hyperkalemia have been described. Generally, these adverse effects have not had serious consequences. Prescription in PHACE syndrome is controversial. In all cases, a cardiologist should assess the patient before treatment begins, blood pressure should be monitored, and pediatric follow-up should be scheduled. This review covers our current understanding of the indications, clinical response, and adverse effects of propranolol, a drug has revolutionized our attitude toward infantile hemangioma and the way we approach therapy. Clinical trials under way are also reviewed.
authors.affiliation: Servicio de Dermatología, Clínica Ruber, Madrid, España. ignacio@ricardoruiz.es
authors.forename: I
authors.initials: I
authors.lastname: Sánchez-Carpintero
authors.forename: R
authors.initials: R
authors.lastname: Ruiz-Rodriguez
authors.forename: J C
authors.initials: JC
authors.lastname: López-Gutiérrez
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001919:Bradycardia / Q000139:chemically induced; D001986:Bronchial Spasm / Q000139:chemically induced; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D006392:Hemangioma, Cavernous / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007022:Hypotension / Q000139:chemically induced; D007223:Infant; D015337:Multicenter Studies as Topic; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D011433:Propranolol / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000150:complications / Q000188:drug therapy*; D012883:Skin Ulcer / Q000188:drug therapy / Q000209:etiology; D013566:Sympathomimetics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D014661:Vasoconstriction / Q000187:drug effects* / Q000502:physiology
chemical_list: D000305:Adrenal Cortex Hormones; D000319:Adrenergic beta-Antagonists; D013566:Sympathomimetics; D011433:Propranolol