Infantile hemangiomas: what therapy should be used as first-line agent?.

By Dra. Florez

 

Dr. Cynthia J. Price and co-workers have just published a very interesting study in the Archives of Dermatology focusing on the controversy propranolol vs corticosteroids when treating infantile hemangiomas (IHs):

Propranolol vs Corticosteroids for Infantile Hemangiomas: A Multicenter Retrospective Analysis.

Price CJ, Lattouf C, Baum B, McLeod M, Schachner LA, Duarte AM, Connelly EA.

Arch Dermatol. 2011 Dec;147(12):1371-6. PMID: 21844428

IHs are frequent, and they can pose challenging clinical scenarios due to bleeding, ulceration and compression of vital structures. In addition, they can have an important cosmetic impact and worsen life quality. When these reasons motivate treatment, corticosteroids used to be the mainstay of therapy, but since 2008 more and more clinicians are in favour of using propranolol as an alternative.

The authors performed a multicenter retrospective study including 110 patients with IHs, with the objective to determine whether propranolol is safe, effective and superior to oral corticosteroids when managing IHs. 68 patients received propranolol with a mean duration of treatment of 7.9 months, and 42 patients received oral corticosteroids with a mean duration of treatment of 5.2 months. The main results the authors underline are the following:

  1. Efficacy: 82% of the patients in the propranolol group achieved clearance of 75% or more, while only 29% of the patients in the corticosteroid group obtained that result (P<.01).
  2. Security: only 1 patient under propranolol developed an adverse effect (hypoglycemia), while every patient in the corticosteroid group (42/42) suffered from 1 or more adverse effects (P<.01).
  3. Surgery due to insufficient response or unacceptable cosmetic outcome: propranolol reduces surgical referrals as only 12% of the patients in the propranolol group needed surgery after treatment compared with 29% of the patients in the corticosteroid group (P=.03).
  4. Ulceration: 26% of the IHs under oral corticosteroids ulcerated, but ulceration was only observed in 6% of the cases under propranolol (P<.01).

 

Based on their findings Dr. Cynthia J. Price et al recommend propranolol as a first-line agent when treating IHs due to its safety and efficacy profile. Although retrospective, this is a very interesting article due to the lack of large published studies regarding this issue. 

 

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