title: Therapeutic superiority of combined propranolol with short steroids course over propranolol monotherapy in infantile hemangioma.
abstract: Infantile hemangiomas are the most common benign childhood tumor that may have functional and/or cosmetic complications. We aimed to compare the clinical efficacy of propranolol alone and propranolol primed with systemic corticosteroids on the outcome of infantile hemangioma. A prospective randomized study included 40 infants aged less than 9 months with cutaneous hemangiomas. Patients were randomly assigned into two groups: group A were given oral prednisolone for the initial 2 weeks combined with oral propranolol, while group B were given oral propranolol alone for 6 months. The median age of the studied patients was 4.5 months (ranged 4 weeks-8 months). Sequential determination of the dimensions of the hemangiomas based on direct measurement and photographic analysis were performed. A significant reduction in the size of the lesions was found in group A in the 2-, 4-, and 8-week evaluation compared to group B (p < 0.001) with no statistical difference in the ultimate 6 month response (p = 0.134). Multiple logistic regression showed that early treatment before 6 months of age (OR 9.82, p = 0.007) and combined treatment with propranolol and prednisolone (OR 10.71, p = 0.006) were the predictors of best response.
  
  
  CONCLUSIONS
  Combining propranolol with corticosteroids gives a faster response and should be considered in treating life- or function-threatening hemangiomas.
authors.affiliation: Pediatric Surgery Department, Ain Shams University, Cairo, Egypt. dr_medodahab@hotmail.com.
authors.forename: Mohamed M D
authors.initials: MM
authors.lastname: Aly
authors.affiliation: Pediatric Surgery Department, Ain Shams University, Cairo, Egypt. alaa_hamza@msn.com.
authors.forename: Alaa F
authors.initials: AF
authors.lastname: Hamza
authors.affiliation: Pediatric Surgery Department, Ain Shams University, Cairo, Egypt. heshamabdelkader@yahoo.com.
authors.forename: Hesham M
authors.initials: HM
authors.lastname: Abdel Kader
authors.affiliation: Pediatric Surgery Department, Ain Shams University, Cairo, Egypt. hatemsaafan@yahoo.com.
authors.forename: Hatem A
authors.initials: HA
authors.lastname: Saafan
authors.affiliation: Radiodiagnosis Department, Ain Shams University, Cairo, Egypt. mohamedshakerghazy@yahoo.com.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Ghazy
authors.affiliation: Hematology-Oncology Unit, Pediatric Department, Ain Shams University, Abbasseya Square, Cairo, Egypt. hragab68@hotmail.com.
authors.forename: Iman A
authors.initials: IA
authors.lastname: Ragab
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006391:Hemangioma / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D011433:Propranolol / Q000627:therapeutic use*; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D005938:Glucocorticoids; D011239:Prednisolone; D011433:Propranolol
keywords: Combined treatment; Infantile hemangioma; Propranolol