Propranolol for infantile hemangiomas in developing countries.
BACKGROUND
Propranolol is the treatment of choicefor complicated infantile hemangiomas (IH). However,in some locations, propranolol has not yet becomestandard of care. To our knowledge, until 2014,propranolol had not been used in Afghanistan totreat IH.


OBJECTIVE
To raise further awareness thatpropranolol is the treatment of choice for complicatedIH, suggest a propranolol induction, maintenance,and taper protocol, show an example of therapeuticsuccess in a resource-limited country, and discusspotential challenges.


METHODS
At an academicteaching hospital in Kabul, Afghanistan, we conducteda retrospective chart review of patients treated withpropranolol for IH from 2014-2015.


RESULTS
Seventeenpatients were treated using a modified protocol basedon consensus recommendations. Average age was 6.3months (range 2.5 to 18 months). Thirteen patientshad focal IH and four had large segmental facial IH.Three patients were lost to follow-up. The remaining14 had good response and very few complications,including one patient co-managed by utilizing storeand-forward teledermatology.


CONCLUSIONS
Patientsin resource-limited countries can be managedsuccessfully using a modified version of a propranololinduction, maintenance, and taper protocol. Indeveloping countries where dermatologists arescarce, we suggest IH may be co-managed withprimary care physicians via teledermatology.
Josette
J
McMichael
Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia. leslie.lawley@emory.edu.
Leslie P
LP
Lawley
D000346:Afghanistan; D003906:Developing Countries; D005153:Facial Neoplasms / Q000188:drug therapy*; 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*; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D011433:Propranolol