title: Rebound Growth of Infantile Hemangiomas After Propranolol Therapy.
abstract: OBJECTIVE
  Propranolol is first-line therapy for problematic infantile hemangiomas (IHs). Rebound growth after propranolol discontinuation is noted in 19% to 25% of patients. Predictive factors for rebound are not completely understood and may alter the management approach. The goal of the study was to describe a cohort of patients with IHs treated with propranolol and to identify predictors for rebound growth.
  
  
  METHODS
  A multicenter retrospective cohort study was conducted in patients with IHs treated with propranolol. Patient demographic characteristics, IH characteristics, and specifics of propranolol therapy were obtained. Episodes of rebound growth were recorded. Patients' responses to propranolol were evaluated through a visual analog scale.
  
  
  RESULTS
  A total of 997 patients were enrolled. The incidence of rebound growth was 231 of 912 patients (25.3%). Mean age at initial rebound was 17.1 months. The odds of rebound among those who discontinued therapy at <9 months was 2.4 (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.3 to 4.5; P = .004) compared with those who discontinued therapy between 12 to 15 months of life. Female gender, location on head and neck, segmental pattern, and deep or mixed skin involvement were associated with rebound on univariate analysis. With multivariate analysis, only deep IHs (OR: 3.3; 95% CI: 1.9 to 6.0; P < .001) and female gender (OR: 1.7; 95% CI: 1.1 to 2.6; P = .03) were associated. Of those with rebound growth, 83% required therapeutic modification including 62% of patients with modifications in their propranolol therapy.
  
  
  CONCLUSIONS
  Rebound growth occurred in 25% of patients, requiring modification of systemic therapy in 15%. Predictive factors for rebound growth included age of discontinuation, deep IH component, and female gender. Patients with these predictive factors may require a prolonged course of therapy.
authors.affiliation: Departments of Dermatology and sonal.shah@ucsf.edu.
authors.forename: Sonal D
authors.initials: SD
authors.lastname: Shah
authors.affiliation: Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain;
authors.forename: Eulalia
authors.initials: E
authors.lastname: Baselga
authors.affiliation: Division of Dermatology (Pediatrics), CHU Sainte-Justine, University of Montreal, Montreal, Canada;
authors.forename: Catherine
authors.initials: C
authors.lastname: McCuaig
authors.affiliation: Department of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Canada;
authors.forename: Elena
authors.initials: E
authors.lastname: Pope
authors.affiliation: Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires St Luc, Brussels, Belgium;
authors.forename: Julien
authors.initials: J
authors.lastname: Coulie
authors.affiliation: Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires St Luc, Brussels, Belgium;
authors.forename: Laurence M
authors.initials: LM
authors.lastname: Boon
authors.affiliation: Departments of Dermatology and Pediatrics, Columbia University, New York, New York;
authors.forename: Maria C
authors.initials: MC
authors.lastname: Garzon
authors.affiliation: Departments of Dermatology and Pediatrics, Indiana University, School of Medicine, Indianapolis, Indiana;
authors.forename: Anita N
authors.initials: AN
authors.lastname: Haggstrom
authors.affiliation: Department of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio;
authors.forename: Denise
authors.initials: D
authors.lastname: Adams
authors.affiliation: Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin;
authors.forename: Beth A
authors.initials: BA
authors.lastname: Drolet
authors.affiliation: Division of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; and.
authors.forename: Brandon D
authors.initials: BD
authors.lastname: Newell
authors.affiliation: Division of Dermatology (Pediatrics), CHU Sainte-Justine, University of Montreal, Montreal, Canada;
authors.forename: Julie
authors.initials: J
authors.lastname: Powell
authors.affiliation: Department of Dermatology, National Institute of Pediatrics, Mexico City, Mexico.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: García-Romero
authors.affiliation: Department of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio;
authors.forename: Carol
authors.initials: C
authors.lastname: Chute
authors.affiliation: Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain;
authors.forename: Esther
authors.initials: E
authors.lastname: Roe
authors.affiliation: Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin;
authors.forename: Dawn H
authors.initials: DH
authors.lastname: Siegel
authors.affiliation: Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California;
authors.forename: Barbara
authors.initials: B
authors.lastname: Grimes
authors.affiliation: Departments of Dermatology and.
authors.forename: Ilona J
authors.initials: IJ
authors.lastname: Frieden
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006391:Hemangioma / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011433:Propranolol / Q000008:administration & dosage*; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol