title: Shouldn't Propranolol Be Used to Treat All Haemangiomas?
abstract: BACKGROUND
  Infantile haemangioma is the most common childhood tumour. These tumours can cause significant functional and cosmetic problems. While there are many treatment modalities, propranolol is increasingly being recognised as the first-line treatment of problematic haemangiomas. This study investigates the use of oral propranolol for the treatment of all haemangiomas at a tertiary children's hospital.
  
  
  METHODS
  This is a retrospective study evaluating 15 children (3 boys and 12 girls) presenting at a tertiary children's hospital with infantile haemangioma during a 24-month period. The protocol consisted of pre-treatment ultrasonic evaluation of the lesion, followed by the commencement of propranolol therapy (2 mg/kg orally in two divided doses), with repeat imaging performed at 16-24 weeks in order to document the dimensional changes. Adverse effects of propranolol were documented. Intralesional bleomycin was utilised as a second-line modality of treatment for large or problematic haemangiomas with inadequate regression in size after oral propranolol therapy.
  
  
  RESULTS
  Fifteen (15) patients with a mean age of 7 months (Range: 3-14 months) presented with haemangiomas. Ten patients presented with lesions affecting the head and neck region (67%). Three patients presented with an ulcerated haemangioma, which responded to propranolol and simple dressings and all healed completely. The average decrease in size between the ultrasonography procedures was 48.87%. Only one patient showed no improvement. No side effects were reported. Concomitant bleomycin treatment was reserved for large problematic haemangiomas and proved successful at speeding up the involution process.
  
  
  CONCLUSIONS
  This study suggests that propranolol become the first-line treatment of choice for all haemangiomas. It has proven to be effective and safe for reducing the size of all haemangiomas during the proliferative phase.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Groote Schuur Hospital, University of Cape Town, H53 R69, Old Main Building, Observatory, Cape Town, 7925, South Africa. dr.seanmoodley@gmail.com.
authors.forename: Sean T
authors.initials: ST
authors.lastname: Moodley
authors.affiliation: Department of Plastic and Reconstructive Surgery, Groote Schuur Hospital, University of Cape Town, H53 R69, Old Main Building, Observatory, Cape Town, 7925, South Africa.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Hudson
authors.affiliation: Department of Plastic and Reconstructive Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Saleigh
authors.initials: S
authors.lastname: Adams
authors.affiliation: Department of Plastic and Reconstructive Surgery, Groote Schuur Hospital, University of Cape Town, H53 R69, Old Main Building, Observatory, Cape Town, 7925, South Africa.
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Adams
mesh_terms: D005260:Female; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D011433:Propranolol / Q000627:therapeutic use*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy*
chemical_list: D011433:Propranolol
keywords: Haemangiomas; Propranolol; Ultrasound