title: Propranolol for Treatment of Genital Infantile Hemangioma.
abstract: OBJECTIVE
  Genital infantile hemangiomas are vascular anomalies that often require complex management and interdisciplinary care. Propranolol was first used to treat patients with infantile hemangiomas in 2008 and has since gained acceptance as first-line therapy.
  
  
  METHODS
  We review the presentation, course, management and outcomes of all cases of genital infantile hemangiomas managed by propranolol administration at a single institution from April 2010 to July 2014.
  
  
  RESULTS
  During the study period 9 patients with genital infantile hemangiomas were referred to our hemangioma treatment clinic. Propranolol was initially administered under careful outpatient monitoring at a dose of 1 mg/kg daily in 8 patients. One patient, a 700 gm premature infant, was started on therapy in the inpatient setting at 0.5 mg/kg daily, given the history of prematurity. All patients underwent successful increase of dose to at least 2 mg/kg for the observation phase after tolerating the starting doses. One patient discontinued propranolol prematurely per parental request due to concern regarding peripheral vasoconstriction. Otherwise, no patient demonstrated significant hypotension, symptomatic bradycardia, hypoglycemia or other major side effect requiring treatment discontinuation. All patients who continued the treatment protocol had excellent response to therapy.
  
  
  CONCLUSIONS
  Propranolol therapy for genital infantile hemangiomas was successfully initiated and the dosage increased in 9 young children without significant side effects and with marked improvement in all patients who continued on treatment. Propranolol is the only Food and Drug Administration approved therapy for treatment of patients with this vascular anomaly and should be considered first-line therapy for genital infantile hemangiomas.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: tranc@ccf.org.
authors.forename: Christine
authors.initials: C
authors.lastname: Tran
authors.affiliation: Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joan
authors.initials: J
authors.lastname: Tamburro
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Audrey
authors.initials: A
authors.lastname: Rhee
authors.affiliation: Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alex
authors.initials: A
authors.lastname: Golden
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy*; D005834:Genital Neoplasms, Male / Q000188:drug therapy*; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011433:Propranolol / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011433:Propranolol
keywords: genitalia; hemangioma; propranolol