Beta Blocker Associated with Better Outcomes in Treatment of Infantile Hemangiomas

Using the beta blocker propranolol as a treatment of infantile hemangiomas (IHs) was associated with higher rates of lesion clearance, fewer adverse effects, fewer surgical interventions after treatment, and lowers cost in comparison with oral corticosteroids.

IH is a common form of vascular tumor and grows quickly during the first three to 12 months of age. After three to seven years of age, the tumor gradually regresses of its own accord.

This regression, however, is not guaranteed to improve the patient's appearance entirely.

Additionally, IH left untreated may cause scarring, ulceration and recurrent bleeding, as well as vision, hearing, feeding, and defecation impairment.

Patients have also been known to suffer from heart problems, structural abnormalities, cosmetic disfigurement, and/or psychosocial issues.  As such, "IHs often require systemic, surgical and/or laser treatment to avoid these adverse effects," wrote the authors.

Corticosteroids have been used in many cases to treat the condition, and oral prednisolone is the most universal choice. However, studies since the year 2008 have indicated that a beta blocker drug utilized for heart and circulatory issues, propranolol, may also aid in treating IH.

The study—performed by Cynthia J. Price, MD, formerly of the Miller School of Medicine, University of Miami—assessed the use of propranolol in patients with IH who did not suffer from cardiac abnormalities. Also, Price’s team collected data on the best length for the treatment, associated adverse effects, and relapses when treatment ends.

The researchers reviewed the medical charts of 110 patients suffering from IH between the years 2005 and 2010. They divided patients into two groups— patients whose tumor volume was decreased by 75% or more and patients whose tumor clearance was less than 75%— according to photographs and clinical examination.

The researchers found that, of the 68 patients who received propranolol, 56 (82%) experienced a tumor clearance of 75% or more, in comparison to the 12 (29%) of 42 patients who received oral corticosteroids.

Adverse events were observed in only three patients who were administered propranolol, but all 42 patients receiving corticosteroids suffered adverse events.

Relapse occurred in patients who received propranolol after the treatment was completed; following a second round of the same treatment, however, improvement was noticed.

Overall, eight patients (12%) in the propranolol group and 12 patients (29%) in the corticosteroid group required additional surgery.

"In conclusion, our study showed that propranolol therapy was more effective in lesion clearance, required fewer surgical referrals after treatment and demonstrated superior tolerance, with minimal adverse effects. Propranolol proved to be safe in treating IH in our patients as no major adverse effects occurred," reported the authors.

The total average per-patient costs of treatment were $205.32 and $416.00 in the propranolol and oral prednisolone groups, respectively. Usually, treatment with propranolol took place over 7.9 months and treatment with oral corticosteroids took place over 5.2 months.

The authors stated that "propranolol therapy was more cost-effective, with a cost reduction of more than 50% per patient."

This report was published online in Archives of Dermatology.