title: Propranolol and infantile hemangiomas: different routes of administration, a randomized clinical trial.
abstract: Oral propranolol has become the treatment of choice of infantile hemangiomas (IH)s. However, the safety of systemic propranolol is questioned. Topical therapy with 1% propranolol has been reported to be safe and effective. Intralesional (IL) administration may possibly allow safe delivery of higher drug dosages.
  
  
  OBJECTIVE
  To assess the efficacy and safety of two locally administered routes of propranolol (topical and IL), in comparison with its systemic oral use in the treatment of IHs.
  
  
  METHODS
  45 patients with IHs were randomly divided into 3 groups, A, B and C (n = 15 in each), receiving oral propranolol, 2 mg/kg/day, topical propranolol 1% ointment twice daily, IL propranolol, 1 mg of propranolol hydrochloride in 1 ml of injection once weekly, respectively. Follow up was done for 6 months after treatment was stopped.
  
  
  RESULTS
  Excellent response was achieved in 9 patients in group A (60%), 3 in group B (20%) and 2 in group C (13.3%), (P value : 0.04). As regards safety, all 3 modalities proved safe with no major side effects apart from 1 patient in group A and 3 in group C who dropped out due to pain or inconvenience of therapy.
  
  
  CONCLUSIONS
  Further work is needed to establish clear guidelines and reach best formulations. Nevertheless, in properly selected patients with IHs, we recommend the usage of oral propranolol. Topically administered propranolol could be considered in patients at risk of potential side effects from oral administration. As IL application did not offer any more benefits, it could not be recommended.
authors.affiliation: Department of dermatology, Kasr Aini Hospital, 59 street no. 104, Maadi Gardens, Cairo, 11431 Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Zaher
authors.forename: Hoda
authors.initials: H
authors.lastname: Rasheed
authors.forename: Samia
authors.initials: S
authors.lastname: Esmat
authors.forename: Ranya A
authors.initials: RA
authors.lastname: Hegazy
authors.forename: Heba I
authors.initials: HI
authors.lastname: Gawdat
authors.forename: Rehab A
authors.initials: RA
authors.lastname: Hegazy
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Komy
authors.forename: Dalia M
authors.initials: DM
authors.lastname: Abdelhalim
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D004452:Echocardiography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional / Q000009:adverse effects; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010146:Pain / Q000209:etiology; D011433:Propranolol / Q000008:administration & dosage* / Q000009:adverse effects; D016037:Single-Blind Method; D012878:Skin Neoplasms / Q000188:drug therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol
keywords: infantile hemangioma; intralesional; oral; propranolol; side effects; topical