title: [Subsequent therapy for infantile hemangiomas after discontinuation of oral propranolol].
abstract: OBJECTIVE
  To summarize the subsequent therapy experiences for infantile hemangiomas after discontinuation of oral propranolol treatment, and explore the relationships between clinical interventions and types of infantile hemangioma.
  
  
  METHODS
  In this retrospective study from January 2010 to May 2014, a total of 137 infants with hemangiomas undergoing sequential therapy after oral propranolol treatment. There were 41 males and 96 females. The median age was 16 months, ranging from 14 to 25 months. After oral propranolol treatment, the outcomes were evaluated to be grade III in 74 cases, grade IIin 62 cases and grade Ⅰ in 1 case. The types were papula (n=31), telangiectasis (n=11), plump (n=74), deep (n=12) and compound (n=9). The primary sites were 3 cases in scalp, forty-nine in face, thirty-three in trunk, thirty-eight in extremities. Cutis laxa presented in 45 cases, and parenchyma hypertrophy presented in 80 cases. Sequential therapy were performed including laser therapy for 38 cases, intralesional Pingyangmycin injection for 63 cases, and plastic surgery for 16 cases. The efficacy was re-evaluated on a 4-level scale, combined with evaluations of scar, cutis laxa or pigment alteration. SPSS18.0 software package was used for statistical analysis.
  
  
  RESULTS
  Chi-square test showed significant differences between 5 types in occurrence of cutis laxa and parenchyma hypertrophy (x(2)=28.458,68.276, P<0.01). After a follow-up of 6 months to 4 years, the outcomes were evaluated to be grade IV in 122 cases, grade III in 15 cases, without grade IIor gradeⅠ case. There were significant differences in 5 types of infantile hemangiomas before and after sequential therapy( H=53.445, 9.941, 120.324, 17.000, 18.899, P<0.01). Postoperative scar was presented in 2 cases around to joints, and mild pigment alteration was noticed in 2 cases after intralesional Pingyangmycin injection.
  
  
  CONCLUSIONS
  Cutis laxa and parenchyma hypertrophy may be more likely present in infantile hemangiomas after oral propranolol treatment. Laser therapy is recommended for patients with papula or telangiectasis, when necessary, intralesional Pingyangmycin injection should be combined. Intralesional Pingyangmycin injection should be the first choice for plump or compound type，whereas surgery should be executed in patients with deep type or other plump type complicated by severe hyperplasia, after which combined intralesional Pingyangmycin injection may be required for postoperative superficial residues.
authors.affiliation: Department of Hemangiomas, Linyi Tumor Hospital. Linyi 276001,China. E-mail:doudebao@163.com.
authors.forename: Mao-zhong
authors.initials: MZ
authors.lastname: Tai
authors.affiliation: Department of Oncology, People's Hospital of Economic Development Zone. Linyi 276023, Shandong Province,China.
authors.forename: Xue-jian
authors.initials: XJ
authors.lastname: Liu
authors.affiliation: Department of Hemangiomas, Linyi Tumor Hospital. Linyi 276001,China.
authors.forename: Zhong-ping
authors.initials: ZP
authors.lastname: Qin
authors.affiliation: Department of Hemangiomas, Linyi Tumor Hospital. Linyi 276001,China.
authors.forename: Chun-xiao
authors.initials: CX
authors.lastname: Ge
authors.affiliation: Department of Hemangiomas, Linyi Tumor Hospital. Linyi 276001,China.
authors.forename: Ke-lei
authors.initials: KL
authors.lastname: Li
authors.affiliation: Department of Hemangiomas, Linyi Tumor Hospital. Linyi 276001,China.
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
mesh_terms: D000284:Administration, Oral; D001761:Bleomycin / Q000031:analogs & derivatives; D002675:Child, Preschool; D005145:Face; D005260:Female; D006391:Hemangioma / Q000628:therapy*; D006801:Humans; D006965:Hyperplasia; D006984:Hypertrophy; D007223:Infant; D015552:Injections, Intralesional; D008297:Male; D011184:Postoperative Period; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D013518:Surgery, Plastic; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D001761:Bleomycin; C025703:bleomycetin; D011433:Propranolol