title: Treatment of problematic infantile hemangiomas with propranolol: a series of 40 cases and review of the literature.
abstract: Infantile hemangiomas (IH) are neoplastic proliferations of endothelial cells which occur with an incidence of 10 to 12% within the first year of life. IH grow after birth and usually regress spontaneously, but still can lead to deformities when they are located in the facial areas of the lip, eyelid, nasal tip or the ear. We wanted to share our experience in the treatment of problematic IH with propranolol. A retrospective review of medical charts was performed for 40 consecutive children treated with propranolol because of problematic IH between 2009 and 2012. 40 patients (33 girls, 7 boys) with a median age of 4.2 months (aged 1 to 11 months) were treated because of problematic IH. Rapid improvement was reported in the first days of treatment in 38 patients. In one case we had to terminate the treatment because serious tachycardia developed within the first 48 hours after propranolol was started. In this case the patient benefited from alternative treatment with timolol maleate gel. 35 patients (87%) showed an excellent response with complete resolution of the lesion. 4 patients (10%) showed a good result with >50% reduction in the size of the hemangioma. Also a patient with residual IH after terminating oral propranolol benefited from topical treatment with timolol maleate gel. A minor side effect was poor weight gain during prolonged treatment in one patient and tachycardia in another patient in which case we had to terminate the treatment.
  
  
  CONCLUSIONS
  Our observations show that gradually increasing the dosage of propranolol up to 3 mg/kg and gradually weaning the dosage is safe and effective in treatment of problematic IH. Timolol maleate gel should be considered as a complementary treatment for residual hemangiomas after terminating propranolol treatment or as an alternative treatment in patients who do not tolerate oral propranolol well.
authors.affiliation: Pediatric Surgery Department, Medical University of Bialystok, Poland.
authors.forename: Marzanna
authors.initials: M
authors.lastname: Oksiuta
authors.affiliation: Pediatric Surgery Department, Medical University of Bialystok, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Matuszczak
authors.affiliation: Pediatric Surgery Department, Medical University of Bialystok, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Dębek
authors.affiliation: Pediatric Surgery Department, Medical University of Bialystok, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Dzienis-Koronkiewicz
authors.affiliation: Pediatric Surgery Department, Medical University of Bialystok, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Hermanowicz
authors.affiliation: Pediatric Surgery Department, Medical University of Bialystok, Poland.
authors.forename: Marzena
authors.initials: M
authors.lastname: Tylicka
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D005260:Female; D018324:Hemangioma, Capillary / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods; D007231:Infant, Newborn; D008297:Male; D009386:Neoplastic Syndromes, Hereditary / Q000188:drug therapy*; D011433:Propranolol / Q000627:therapeutic use*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol