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Wang L, Wang W, Zhou Z, Li J, Li Z, Lv R, Xu G, Bi J, Huo R. Exploration of the optimal time to discontinue propranolol treatment in infantile hemangiomas: A prospective study. J Am Acad Dermatol 2024; 90:783-789. [PMID: 38159645 DOI: 10.1016/j.jaad.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/15/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Relapse of infantile hemangiomas after withdrawal from propranolol treatment is common. Early withdrawal is believed to increase the risk of relapse. OBJECTIVE The objective of this study was to determine the optimal time to discontinue propranolol treatment for infantile hemangiomas. METHODS A prospective study conducted at a tertiary referral center. RESULTS Compared to withdrawal after 1-month maintenance treatment, withdrawal after 3-month maintenance, corresponding achieving maximum regression of infantile hemangiomas, was associated with a lower major relapse rate (P = .041). The relapse (P = .055) and adverse event rates (P = .154) between the 2 withdrawal modes were not statistically significant. Compared with direct withdrawal, the relapse (P = .396), major relapse (P = .963), and adverse event rates (P = .458) of gradual withdrawal were not statistically different. Patients with/without relapse could be best distinguished according to whether withdrawal followed a 3-month maintenance and age >13 months (area under the receiver operating characteristic curve = 0.603). Patients with/without major relapse could be best distinguished according to whether withdrawal was accompanied by 3-month maintenance (area under the receiver operating characteristic curve = 0.610). LIMITATIONS The limitations of this study are nonrandomization and single-center design. CONCLUSIONS The optimal propranolol withdrawal time to avoid relapse is when the patient is aged >13 months and the lesion has maintained for 3 months after reaching maximum regression, while the optimal time to prevent major relapse is after 3 months of maintenance.
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Affiliation(s)
- Luying Wang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China; Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenjing Wang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zifu Zhou
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jing Li
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhiyu Li
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Renrong Lv
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guangqi Xu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jianhai Bi
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ran Huo
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
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Colmenero Sendra M, Del Boz González J, Segura Palacios JM, Valladares Millán I, Eguiluz Solana M, de Troya Martín M. [Translated article] Nadolol for Infantile Hemangiomas Previously Treated with Propranolol. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T215-T217. [PMID: 38048940 DOI: 10.1016/j.ad.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/24/2023] [Indexed: 12/06/2023] Open
Affiliation(s)
- M Colmenero Sendra
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain.
| | | | | | | | - M Eguiluz Solana
- Unidad de Farmacia Hospitalaria, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - M de Troya Martín
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, Spain
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Colmenero Sendra M, Del Boz González J, Segura Palacios JM, Valladares Millán I, Eguiluz Solana M, de Troya Martín M. Nadolol for Infantile Hemangiomas Previously Treated with Propranolol. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:215-217. [PMID: 37356545 DOI: 10.1016/j.ad.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023] Open
Affiliation(s)
- M Colmenero Sendra
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España.
| | | | | | | | - M Eguiluz Solana
- Unidad de Farmacia Hospitalaria, Hospital Costa del Sol, Marbella, Málaga, España
| | - M de Troya Martín
- Servicio de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España
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Ghahvehchian H, Kashkouli MB, Ghanbari S, Karimi N, Abdolalizadeh P, Abri Aghdam K. Long-Term Results of Oral Propranolol Treatment Protocol for Periocular Infantile Hemangioma: Should There Be Any Contraindication? Ophthalmic Plast Reconstr Surg 2024; 40:61-69. [PMID: 38241619 DOI: 10.1097/iop.0000000000002507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
PURPOSE The authors report long-term results of the oral propranolol treatment protocol for periocular infantile hemangioma regardless of conventional indications. METHODS This is a retrospective study (2008-2018) on children with propranolol treatment protocol for periocular infantile hemangioma and last follow-up (FU) of ≥4 months after treatment and age of >24 months. After systemic evaluation, it was started with 0.5 and increased by 0.5 every 3 days to reach 2 mg/kg/day. If there was no good response, it would be gradually increased up to 3 mg/kg/day. Tapering (0.5 mg/kg/day every 4 weeks) was started when patients were on treatment for ≥6 months and ≥12 months old and there was no change in the infantile hemangioma size for ≥3 months. Rebound growth was based on the parents' report and would be treated by increasing the dose to at least 2 mg/kg/day for 3 months. FU was either in-person or via social media. Change in periocular infantile hemangioma size on the photos was scored by 3 masked observers (visual analog scale) and presented as excellent (≥50% reduction), good (1%-49%), fair (no change), and failure (enlarged). RESULTS Forty-three patients were included. Orbital involvement was in 49%, ptosis in 58%, and risk of amblyopia in 63%. Mean treatment, tapering, and FU duration were 37, 13, and 74 months, respectively. Mean age at presentation, start of propranolol treatment protocol, tapering, stop, and last FU were 1.5, 5, 29, 42, and 78 months, respectively. Twenty-seven patients received 2, seven 2.5, and nine 3 mg/kg/day. Mean visual analog scale significantly increased from 43% (FU1) to 92% (last FU) when 97.6% of patients showed an excellent response. The remaining skin lesions were observed in 35%. No side effect was reported. CONCLUSIONS Long-term results of the propranolol treatment protocol for periocular infantile hemangioma showed an excellent response in 97.6% of patients with no side effects. A residual skin lesion was observed in 1/3 of the patient.
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Affiliation(s)
- Hossein Ghahvehchian
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahmani Kashkouli
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
| | - Shaghayegh Ghanbari
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Nasser Karimi
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Abdolalizadeh
- Department of Ophthalmology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Kaveh Abri Aghdam
- Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Mauguen C, Maruani A, Barbarot S, Abasq C, Martin L, Herbert J, Goronflot T, Gourraud PA, Happe A, Descatha A, Chrétien JM, Beuchée A, Adamski H, Dupuy A, Bouzillé G, Oger E, Droitcourt C. Factors associated with early relapse of infantile haemangioma in children treated for at least six months with oral propranolol: A case-control study using the 2014-2021 French Ouest DataHub. Ann Dermatol Venereol 2023; 150:189-194. [PMID: 37225615 DOI: 10.1016/j.annder.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/08/2022] [Accepted: 03/24/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The factors associated with early relapse of infantile haemangioma (IH) after a first course of treatment with oral propranolol for at least six months (initiated after the marketing authorization had been granted) have not previously been investigated. OBJECTIVES To identify factors associated with the risk of early relapse in children with IH treated with oral propranolol according to the current prescribing guidelines. METHODS We performed a multicentre, retrospective, case-control study, using the Ouest Data Hub database. All children treated for at least 6 months with oral propranolol for IH between 31 June 2014 and 31 December 2021, and with a follow-up visit at least three months after treatment discontinuation were included. A case was defined as relapse of IH within three months of treatment discontinuation; each case was matched for age at treatment initiation and for centre, with four (relapse-free) controls. The association between relapse and treatment or IH characteristics was expressed as an odds ratio (OR) from univariate and multivariate conditional logistic regressions. RESULTS A total of 225 children were included. Of these, 36 (16%) relapsed early. In a multivariate analysis, a deep IH component was a risk factor for early relapse [OR = 8.93; 95%CI: 1.0-78.9, p = 0.05]. A propranolol dosage level of less than 3 mg/kg/day protected against early relapse [OR = 0.11; 95%CI: 0.02-0.7, p = 0.02]. Tapering before propranolol discontinuation was not associated with a lower risk of early relapse. CONCLUSION The risk factors for late and early relapse are probably different. Investigation of the risk factors for early vs. late IH relapse is now warranted.
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Affiliation(s)
- C Mauguen
- Department of Dermatology, CHU Rennes, 35000 Rennes, France.
| | - A Maruani
- University of Tours, INSERM 1246-SPHERE, Department of Dermatology, Tours University Hospital, F-37000 Tours, France; Dermatology Department and Reference Centre for Rare Diseases and Vascular Malformations (MAGEC), Tours University Hospital, 37000 Tours, France
| | - S Barbarot
- Department of Dermatology, CHU Nantes and INSERM CIC 004, 44000 Nantes, France
| | - C Abasq
- Department of Dermatology, Brest University Hospital, 29200 Brest, France
| | - L Martin
- Department of Dermatology, Angers University Hospital, 4, rue Larrey, 49933 Angers, France
| | - J Herbert
- Clinical Data Centre, Public Health and Prevention Unit, Tours University Hospital, 37044 Tours, France
| | - T Goronflot
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, 44000 Nantes, France
| | - P-A Gourraud
- Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, 44000 Nantes, France
| | - A Happe
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - A Descatha
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 49000 Angers, France
| | - J-M Chrétien
- Clinical Research Department, Angers University Hospital, 49000 Angers, France
| | - A Beuchée
- Department of Neonatalogy, Rennes University Hospital, Rennes, France
| | - H Adamski
- Department of Dermatology, CHU Rennes, 35000 Rennes, France
| | - A Dupuy
- Department of Dermatology, CHU Rennes, 35000 Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - G Bouzillé
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 35000 Rennes, France
| | - E Oger
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Centre, Department of Clinical Pharmacology, Rennes University Hospital, 35000 Rennes, France
| | - C Droitcourt
- Department of Dermatology, CHU Rennes, 35000 Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
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Ziad K, Badi J, Roaa Z, Emily AH. Laser treatment of infantile hemangioma. J Cosmet Dermatol 2023; 22 Suppl 2:1-7. [PMID: 36774645 DOI: 10.1111/jocd.15671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/10/2023] [Accepted: 01/25/2023] [Indexed: 02/13/2023]
Abstract
BACK GROUNDS AND OBJECTIVE Infantile hemangiomas (IH) are common benign tumors of infancy. Most IH either involute spontaneously or respond to treatment with systemic Beta- blockers, but unfortunately not in all cases. In poor responses or in cases of contra indications for pharmacological treatment, laser treatment poses a very good solution. METHODS As a search strategy and study selection we searched the MEDLINE database via PubMed starting 1982 to June 2022 using a key terms related to interventions for IH (e.g., infantile hemangioma, laser, Beta blockers). RESULTS In this article, we reviewed the published data regarding the use of energy-based devices in treatment of children with IH, and noted our experience over the course of treating dozens of cases over the years. CONCLUSION There are many laser systems used for the treatment of hemangioma and vascular tumors. These laser systems are of different wavelengths and penetration depths, however, they operate by similar mechanisms and in some cases two or more lasers can be applied during the course of treating these lesions.
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Affiliation(s)
- Khamaysi Ziad
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Jiryis Badi
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Zoabi Roaa
- Clalit Medical Services, Tel Aviv-Yafo, Israel
| | - Avitan-Hersh Emily
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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Khamaysi Z, Pam N, Zaaroura H, Avitan-Hersh E. Nd:YAG 1064-nm laser for residual infantile hemangioma after propranolol treatment. Sci Rep 2023; 13:7474. [PMID: 37156812 PMCID: PMC10167233 DOI: 10.1038/s41598-023-33870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
Infantile hemangiomas (IH) are common benign tumors of infancy. Most IH involute, either spontaneously, or secondary to pharmacological treatment with systemic propranolol. Propranolol treatment mostly leads to regression of hemangiomas with satisfactory aesthetic results, but unfortunately not in all cases. To assess the safety and efficacy of long pulsed Nd:YAG 1064 nm laser in treating patients with residual infantile hemangioma after systemic propranolol treatment. This is an open-label prospective cohort study. 30 patients with focal residual IH that had sub-optimal responses to systemic propranolol treatment were enrolled in the study. The patients were treated with 1 to 3 sessions with long pulsed Nd:YAG 1064 nm laser. The maximal response of the IH was assessed using a 4-point scale evaluation scale system. Of the 30 patients enrolled, 18 patients exhibited a great response (> 76% improvement), 10 patients had a good response (> 51-75% improvement), while only 2 patients showed a moderate response (< 50% improvement) to the treatment. No patients had an unsatisfactory response. No serious side effects were observed, and only minor side effects were reported. The treatment with long pulsed Nd:YAG 1064 nm laser for residual IH, which were resistant to systemic propranolol treatment, is safe and effective. Thus, we suggest its use as a second-line treatment for patients with sub-optimal aesthetic results following systemic propranolol.
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Affiliation(s)
- Z Khamaysi
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.
| | - N Pam
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - H Zaaroura
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - E Avitan-Hersh
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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Gomes R, Salazar L, Fraga C, Correia MR, Barbosa-Sequeira J, Fernandes A, Álvares S, Banquart Leitão J, Paiva Coelho M. Management of infantile hemangiomas-experience of a tertiary hospital. Eur J Pediatr 2023; 182:1611-1618. [PMID: 36705724 DOI: 10.1007/s00431-023-04827-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/07/2023] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Abstract
The purpose of the study is to describe the experience of a multidisciplinary team in a tertiary hospital regarding the management of Infantile Hemangiomas (IH). The method employed is a retrospective analysis of patients with IH followed in a tertiary pediatric hospital between January 2010 and May 2022. A total of 393 IH were diagnosed (56.7% female), with a median age of 5 months (interquartile range (IQR), 3-10). Imaging investigation was necessary for diagnosis and for exclusion of other IH in 9.2% and 14.3%, respectively. Focal (74.0%) and superficial (59.7%) lesions were more frequent as was facial location (35.9%). Pre-treatment ulceration or hemorrhage occurred in 6.6%. At follow-up, 87.4% regressed partially and 12.6% completely; 2.7% relapsed. Propranolol was started in 30.0% of cases for a median period of 9 months (IQR, 6-12), mainly due to esthetic concerns (41.9%). Side effects occurred in 8.3% (sleep disturbance in 5.1%). Only 1.7% were refractory and 5.9% had a rebound effect. Eleven patients were treated with topical timolol and 41 underwent surgery. Patients that were treated with propranolol had more risk factors (p = 0.016) and presented deeper lesions (p < 0.001) with a larger diameter (p < 0.001); total IH regression was less frequent (p < 0.001). Since 2020, twice-daily dosage was more frequently prescribed than three times daily (p = 0.007) and inpatient initiation of propranolol decreased (p = 0.750), without significant difference in the incidence of adverse reactions, duration of treatment, and lesion evolution. Conclusions: Our protocol proved to be safe and feasible in an outpatient setting and twice daily administration of propranolol was effective. The majority of IH showed at least partial regression. Early detection of high-risk IH is paramount and a multidisciplinary assessment by a specialized team is essential for adequate management. What is Known: • IH are the most common vascular tumors in childhood. Although the majority evolves favorably, treatment may be warranted in selected cases. • Early detection of high-risk IH is paramount, and a multidisciplinary assessment by a specialized team is essential for adequate management. What is New: • One-third of our sample was treated with propranolol. These patients had more risk factors and presented deeper lesions with a larger diameter, and tumor total regression was less frequent. • Our results reinforce safety and feasibility of propranolol initiation in an outpatient setting, including twice daily dosage.
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Affiliation(s)
- Rita Gomes
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal.
| | - Luís Salazar
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Carolina Fraga
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Mário Rui Correia
- Pediatric Surgery Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | | | - Alexandre Fernandes
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Sílvia Álvares
- Pediatric Cardiology Department, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Unit for Multidisciplinary Research in Biomedicine (UMIB), School of Medicine and Biomedical Sciences (ICBAS), Centro Materno Infantil Do Norte Albino Aroso, Porto, Portugal
| | - José Banquart Leitão
- Pediatric Surgery Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Margarida Paiva Coelho
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
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Abstract
Infantile hemangioma (IH) is the most common benign vascular tumor of infancy, affecting about 5% of infants. It has a characteristic growth pattern of early rapid proliferation followed by progressive involution. Although most IH evolve favorably, complications are observed in 10-15% of cases, justifying treatment. For over 10 years now, propranolol has become the first-line therapy for complicated IH, revolutionizing their management and their prognosis. In this article, we review the clinical features, associations, complications/sequelae and therapeutic approaches for IH, focusing on current medical therapy. Indications for treatment and various treatment options, including propranolol and other oral β-blockers, topical timolol, and corticosteroids are presented. Current controversies regarding oral propranolol such as pre-treatment screening, in- vs out-patient initiation of treatment, early and potential long-term side effects and recommended monitoring are discussed.
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Affiliation(s)
- Caroline Colmant
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada.
| | - Julie Powell
- Division of Pediatric Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, QC, Canada
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Schmid F, Hoeger PH. Propranolol response in patients with segmental versus focal facial hemangiomas: A retrospective case-control study. J Am Acad Dermatol 2021; 87:490-491. [PMID: 34752824 DOI: 10.1016/j.jaad.2021.10.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Florian Schmid
- Department of Pediatrics, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | - Peter H Hoeger
- Department of Pediatrics, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany; Department of Pediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
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Börjesson C, Malloizel-Delaunay J, Onnis G, Mazereeuw-Hautier J, Dreyfus I. Value of Doppler ultrasound scans in deciding whether to treat infantile haemangioma with oral propranolol. Ann Dermatol Venereol 2021; 148:233-237. [PMID: 34218938 DOI: 10.1016/j.annder.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/04/2021] [Accepted: 03/15/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Oral propranolol (Pr) must be administered until the end of the proliferation phase of infantile haemangioma (IH). This phase may be difficult to assess, particularly where a deep component is involved. Doppler ultrasound scans (DUS), which identify vascular activity (VA), could assist the clinician in making the correct therapeutic decision (CTD). PATIENTS AND METHODS All children with IH treated with Pr for at least 3 months and up to the age of 9 months, and who also underwent DUS, were enrolled in this retrospective, single-centre, observational study. The quality of DUS as a binary diagnostic test for IH proliferation was assessed, together with its value in deciding whether to discontinue Pr (at the end of the presumed proliferation phase) or resume this drug (in the case of suspected recurrence). RESULTS A total of 29 children were enrolled and 45 DUS were performed. Thirty-nine (87%) DUS were of high quality (80% sensitivity, 95% specificity) and made a major, moderate, or minimal contribution to the CTD in respectively 20%, 60% and 7% of cases. DISCUSSION DUS proved to be a high-value tool. They were essential in some cases of IH, mainly periocular and localised forms, and those involving deep components, in which the question of discontinuing Pr arose (age>1 year) and where clinical examination had not been sufficient to make the CTD. Furthermore, in the vast majority of cases, they provide a helpful examination and complement clinical findings in terms of patient follow-up and reaching a CTD. CONCLUSION DUS is an effective and complementary tool to clinical investigation.
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Affiliation(s)
- C Börjesson
- Department of Dermatology and Venereology, Reference Centre for Rare Skin Disorders, University Hospital of Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex 9, France.
| | - J Malloizel-Delaunay
- Department of Vascular Medicine, University Hospital of Toulouse, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse Cedex 9, France
| | - G Onnis
- Department of Dermatology and Venereology, Reference Centre for Rare Skin Disorders, University Hospital of Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex 9, France
| | - J Mazereeuw-Hautier
- Department of Dermatology and Venereology, Reference Centre for Rare Skin Disorders, University Hospital of Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex 9, France
| | - I Dreyfus
- Department of Dermatology and Venereology, Reference Centre for Rare Skin Disorders, University Hospital of Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex 9, France
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Pam N, Kridin K, Khamaysi Z. Propranolol for infantile hemangioma: Evaluating efficacy and predictors of response and rebound growth. Dermatol Ther 2021; 34:e14936. [PMID: 33704861 DOI: 10.1111/dth.14936] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/13/2021] [Indexed: 12/26/2022]
Abstract
Propranolol emerged as the first-line therapy for infantile hemangioma (IH). Determinants of interindividual variation in drug response and predictors of rebound growth after drug discontinuation are yet to be firmly established. We aimed to evaluate the outcomes of a relatively large cohort of patients with IH treated by propranolol and to determine predictors of (a) an excellent response to treatment (≥90 improvement) and (b) of rebound growth after drug cessation. A retrospective cohort study was conducted to follow all patients with IH receiving systemic propranolol in a referral center-based specialized clinic. Multivariate logistic regression analysis was performed to identify predictors of excellent response and rebound growth. The study included 206 patients who completed oral propranolol treatment. The mean (SD) age in which the drug was initiated was 4.8 (3.1) months. The average improvement rate was estimated at 85.5 (13.8)%. Initiation of propranolol at the age of 0 to 3 (adjusted odds ratio [OR], 3.43; 95% confidence interval [CI], 1.25-9.40; P = .016) and 3 to 6 (adjusted OR, 3.71; 95% CI, 1.50-9.19; P = .005) months was associated with an increased likelihood of excellent response. Twenty-four (11.7%) patients developed rebound growth following cessation of propranolol. No significant predictors of rebound were identified in the multivariate analysis. Eleven (5.3%) patients experienced mild adverse events, which necessitated drug discontinuation in only two (1.0%) patients. Propranolol is highly effective and safe based on the real-life experience of a referral center for IH. The current study supports early initiation of propranolol.
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Affiliation(s)
- Nadav Pam
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ziad Khamaysi
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Frongia G, Byeon JO, Mehrabi A, Günther P. Recurrence rate of infantile hemangioma after oral propranolol therapy. Eur J Pediatr 2021; 180:585-590. [PMID: 33188478 DOI: 10.1007/s00431-020-03872-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 11/26/2022]
Abstract
Oral propranolol is the treatment of choice for infantile hemangiomas. The growth relapse rate following oral propranolol therapy is not well established in the literature. The present study aimed at determining predictors of growth relapse of infantile hemangiomas after discontinuation of oral propranolol therapy. A retrospective analysis was performed of all cases of infantile hemangiomas aged ≤ 12 months undergoing oral propranolol therapy in a 6-year period. Of the 198 cases, regrowth after oral propranolol therapy was observed in 35 patients (18%). Facial hemangiomas showed a higher (p = 0.003) relapse rate as compared with other hemangiomas (27 out of 107 facial cases vs. 8 out of 91 with other location, respectively 25% and 8.8%). Of 35 growth relapses cases, 66% of cases (23 in total, 18 facial and 5 otherwise located hemangiomas) underwent a second cycle of oral propranolol therapy (median length of treatment 3 months, interquartile range 2-3). All cases had a successful outcome, either after a single cycle oral propranolol therapy (163 cases, 82%), or in case of regrowth, after a second therapy cycle (23 cases, 12%) or further conservative management (12 cases, 6%).Conclusion: Facial infantile hemangiomas relapse earlier and more frequently after oral propranolol therapy. We suggest to closely monitor these patients, as a second cycle of propranolol may be indicated. Prolonged oral propranolol therapy might be considered for facial infantile hemangiomas. What is Known: • Oral propranolol is the treatment of choice for infantile hemangiomas. • The growth relapse rate following oral propranolol is not well established. What is New: • The present study points out that facial infantile hemangioma relapse earlier and more frequently after oral propranolol therapy. • Patients with facial infantile hemangiomas should be monitored after propranolol therapy discontinuation.
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Affiliation(s)
- Giovanni Frongia
- Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Ji-Oun Byeon
- Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
| | - Patrick Günther
- Division of Pediatric Surgery, Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Heidelberg, Germany
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Leung AKC, Lam JM, Leong KF, Hon KL. Infantile Hemangioma: An Updated Review. Curr Pediatr Rev 2021; 17:55-69. [PMID: 32384034 DOI: 10.2174/1573396316666200508100038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life. OBJECTIVE To familiarize physicians with the natural history, clinical manifestations, diagnosis, and management of infantile hemangiomas. METHODS A Pubmed search was conducted in November 2019 in Clinical Queries using the key term "infantile hemangioma". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS The majority of infantile hemangiomas are not present at birth. They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches. Then, they grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated. Deep lesions are bluish and dome-shaped. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child. Involution typically begins by the time the child is a year old. Approximately 50% of infantile hemangiomas will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by 10 to 12 years of age. The majority of infantile hemangiomas require no treatment. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement. CONCLUSION Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options. Currently, oral propranolol is the treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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15
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Fernandez Faith E, Cordisco M. Unrelenting facial segmental hemangiomas: A case series of late growth and recurrent ulcerations. Pediatr Dermatol 2020; 37:884-889. [PMID: 32639025 DOI: 10.1111/pde.14253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 12/27/2022]
Abstract
Late growth of infantile hemangiomas is an uncommon complication. We report three patients with segmental facial hemangiomas who experienced late growth and recurrent ulceration predominantly of the lower lip. These patients shared common clinical features including involvement of the S3 facial segment, oral and airway hemangiomas, and vascular anomalies associated with PHACE syndrome. This report highlights a clinical presentation at-risk for late growth and recurrent ulceration.
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Affiliation(s)
- Esteban Fernandez Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Maria Cordisco
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
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Hartmann F, Lockmann A, Himpel O, Kühnle I, Hensen J, Schön MP, Thoms K. Orale Propranolol‐ und Neodym:YAG‐Farbstofflaser‐Kombinationstherapie infantiler Hämangiome: eine retrospektive Analyse von 30 Kindern mit 48 Hämangiomen. J Dtsch Dermatol Ges 2020; 18:984-994. [DOI: 10.1111/ddg.14184_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Franziska Hartmann
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Anike Lockmann
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Okko Himpel
- Klinik für Kinder‐ und Jugendmedizin Universitätsmedizin Göttingen
| | - Ingrid Kühnle
- Klinik für Kinder‐ und Jugendmedizin Universitätsmedizin Göttingen
| | - Janina Hensen
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Michael P. Schön
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Kai‐Martin Thoms
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
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17
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Hartmann F, Lockmann A, Himpel O, Kühnle I, Hensen J, Schön MP, Thoms KM. Combination therapy of oral propranolol and combined Nd:YAG/pulsed dye laser therapy in infantile hemangiomas: a retrospective analysis of 48 treated hemangiomas in 30 children. J Dtsch Dermatol Ges 2020; 18:984-993. [PMID: 32856787 DOI: 10.1111/ddg.14184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/27/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Infantile hemangiomas can be successfully treated by both systemic propranolol and neodymium:YAG (Nd:YAG)-dye laser combination therapy. In this retrospective study, the efficacy and safety of sequential and parallel therapy of complicated hemangiomas treated with both methods were evaluated. PATIENTS AND METHODS 30 children with 48 complicated hemangiomas were treated with propranolol and Nd:YAG-dye laser combination therapy. Using photo comparison, the percentage remission rate was evaluated by three investigators on a four-step scale (I: 0-25 %, II: 26-50 %, III: 51-75 % and IV: 76-100 %). RESULTS Eleven children received propranolol and laser therapy in parallel (A), twelve children received laser therapy after propranolol (B) and seven children received propranolol after laser therapy (C). Due to emigration abroad, one child was lost to follow-up. A strong improvement (IV) was observed in 23/29 (79.3 %) of all treated children (A: 90.9 %, B 75 %, C 66.7 %). The mean duration of propranolol therapy in all children was 8.6 months (A: 8.9 months, B: 8.2 months, C: 8.9 months). On average, 2.33 laser treatments were performed per hemangioma (A: 1.95, B: 3.2, C: 1.91). Serious side effects caused by propranolol and laser therapy were not observed. CONCLUSIONS Propranolol and Nd:YAG-dye laser combination therapy can be used sequentially or in parallel safely and effectively. They complement each other in a meaningful manner.
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Affiliation(s)
- Franziska Hartmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
| | - Anike Lockmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
| | - Okko Himpel
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen
| | - Ingrid Kühnle
- Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen
| | - Janina Hensen
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
| | - Kai-Martin Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center Goettingen
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18
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Ulcerated Infantile Hemangioma of the Hard Palate: Diagnostic Treatment With Oral Propranolol. J Craniofac Surg 2020; 31:e600-e602. [PMID: 32649551 DOI: 10.1097/scs.0000000000006666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infantile hemangiomas arising in the palate are rare. The authors describe a case of ulcerated infantile hemangioma of the hard palate with feeding difficulty. To our knowledge, this is the first reported case of immunohistochemically diagnosed palatal infantile hemangioma successfully treated using oral propranolol.
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19
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Anger J, Oliveira EMD, Gabel J. EFFECTIVENESS OF FIXED DOSES OF PROPRANOLOL IN THE TREATMENT OF HEMANGIOMAS REGARDLESS OF CHILD'S WEIGHT GAIN: A CASE REPORT. ACTA ACUST UNITED AC 2019; 37:392-395. [PMID: 31090848 PMCID: PMC6868553 DOI: 10.1590/1984-0462/;2019;37;3;00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present the outcomes of fixed doses of propranolol tablets for the treatment of hemangiomas. CASE DESCRIPTION Two illustrative cases of hemangioma in infant patients younger than six months old are described. Treatments were started in 2010 and 2011 and were monitored until August 2017. Patients were treated with fixed doses, initially calculated based on the upper limit of 3 mg/kg/day and administrated in two daily doses rounded down to the nearest multiple of five milligrams. Dosage was not adjusted to patients' weight gain. The tablets were crushed and then diluted in a maximum amount of 3 mL of water. This procedure was necessary because propranolol was not available in oral solution in 2009, when dosages available in the Brazilian market were 10, 40 and 80 mg. Both patients presented significative improvement in the first 60 days and were in complete remission by the end of the treatment. COMMENTS It is possible to treat patients with Propranolol 10 mg tablets, even though the dosage is not as precise as when calculated according to patients' weight. The maintenance of a fixed dose, ignoring the patient's progressive weight gains, helps avoiding the rebound effect and decreases complications.
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Affiliation(s)
- Jaime Anger
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - José Gabel
- Project "Einstein na Comunidade Paraisópolis", São Paulo, SP, Brazil
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20
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Combination of Sclerotherapy and Dual-Wavelength Laser in the Management of Infantile Hemangiomas in Chinese Infants. Dermatol Surg 2019; 45:1253-1259. [PMID: 30882500 DOI: 10.1097/dss.0000000000001898] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of combination therapy with sclerotherapy and dual-wavelength pulsed dye laser (PDL) & Nd:YAG for infantile hemangiomas (IHs). PATIENTS AND METHODS Fifty-nine patients with IH received treatment with sclerotherapy and dual-wavelength PDL & Nd:YAG treatment at 4-week intervals. Observers assessed the size and color of IH using a size rating scale and color rating scale before and after treatments. RESULTS The study showed that IH improved significantly after several sessions of treatment. Sclerotherapy reduced the size of IH, whereas dual-wavelength laser lightened the color of IH. No serious adverse effects occurred. CONCLUSION Combined sclerotherapy and dual-wavelength laser treatment is an effective and safe option for IH.
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21
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Satterfield KR, Chambers CB. Current treatment and management of infantile hemangiomas. Surv Ophthalmol 2019; 64:608-618. [PMID: 30772366 DOI: 10.1016/j.survophthal.2019.02.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 01/27/2019] [Accepted: 02/04/2019] [Indexed: 12/19/2022]
Abstract
Infantile hemangiomas, otherwise known as infantile capillary hemangiomas, strawberry hemangiomas, or strawberry nevi, are nonmalignant vascular tumors that commonly affect children. The natural disease course typically involves growth for up to a year, followed by regression without treatment over a period of years with no cosmetic or functional sequelae. Less commonly, however, infantile hemangiomas can become a threat to vision or even life depending on location and size of the lesion. In addition, infantile hemangiomas, particularly those involving the face, may be disfiguring and result in lifelong sequelae. β-blockers have become a mainstay of therapy given their relatively low-risk profile and efficacy. Other treatment modalities previously described in the literature include corticosteroids (both intralesional and systemic), imiquimod, vincristine, bleomycin A5, and interferon α. More recently, angiotensin-converting enzyme inhibitors such as captopril have been used. Laser therapy and, less commonly, surgical excision are also available treatment options. We review current recommended management and treatment of capillary hemangiomas and discuss the benefits and risks of all previously reported treatment modalities.
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Affiliation(s)
- Kellie R Satterfield
- Department of Medicine, Scripps Mercy Hospital, San Diego, California, USA; Department of Ophthalmology, University of Washington, Seattle, Washington DC, USA
| | - Christopher B Chambers
- Department of Ophthalmology, University of Washington, Seattle, Washington DC, USA; Department of Oculoplastic and Reconstructive Surgery, University of Washington, Seattle, Washington DC, USA.
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22
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Baselga E, Dembowska-Baginska B, Przewratil P, González-Enseñat MA, Wyrzykowski D, Torrelo A, López Gutiérrez JC, Rychłowska-Pruszyńska M, de Lucas-Laguna R, Esteve-Martinez A, Roé E, Zaim M, Menon Y, Gautier S, Lebbé G, Bouroubi A, Delarue A, Voisard JJ. Efficacy of Propranolol Between 6 and 12 Months of Age in High-Risk Infantile Hemangioma. Pediatrics 2018; 142:peds.2017-3866. [PMID: 30082451 DOI: 10.1542/peds.2017-3866] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is no consensus on optimal treatment duration for propranolol in infantile hemangioma (IH). We evaluated the efficacy and safety of oral propranolol solution administered for a minimum of 6 months up to a maximum of 12 months of age in high-risk IH. METHODS This single-arm, open-label, phase 3 study was conducted in patients aged 35 to 150 days with high-risk IH in 10 hospitals between 2015 and 2017. The study comprised a 6-month initial treatment period (ITP) plus continuation up to 12 months of age if complete success was not achieved, a follow-up, and a retreatment period. Patients received oral propranolol twice daily (3 mg/kg per day). The primary end point was the success rate at the end of the ITP. Furthermore, the persistence of IH response and efficacy of retreatment was evaluated. RESULTS The success rate after 6 months of treatment was 47%, increasing to 76% at the end of the ITP. Of the patients who achieved success, 68% sustained success for 3 months without treatment, and 24% required retreatment. Of the 8 patients who were retreated, 7 achieved success. Adverse events, reported by 80% of patients, were mild, which were expected in this population or known propranolol side effects. CONCLUSIONS Oral propranolol administered beyond 6 months and up to 12 months of age meaningfully increases the success rate in high-risk IH. Success was sustained in most patients up to 3 months after stopping treatment. Retreatment was efficacious, and the safety profile satisfactory.
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Affiliation(s)
- Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
| | | | - Przemysław Przewratil
- Department of Pediatric Oncology and Surgery, Samodzielny Publiczny Zaklad Opieki Zdrowotnej Uniwersytecki Szpital Kliniczny, Uniwersytetu Medycznego w Łodzi, Łódź, Poland
| | | | - Dariusz Wyrzykowski
- Department of Surgery and Urology for Children and Adolescents, Copernicus Podmiot Leczniczy Sp. z o.o, Gdańsk, Poland
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | | | - Esther Roé
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mohammed Zaim
- Institut de Recherche Pierre Fabre, Toulouse, France
| | - Yoann Menon
- Institut de Recherche Pierre Fabre, Toulouse, France
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Rotter A, Samorano LP, Rivitti-Machado MC, Oliveira ZNP, Gontijo B. PHACE syndrome: clinical manifestations, diagnostic criteria, and management. An Bras Dermatol 2018; 93:405-411. [PMID: 29924216 PMCID: PMC6001075 DOI: 10.1590/abd1806-4841.20187693] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/07/2018] [Indexed: 11/25/2022] Open
Abstract
Infantile hemangioma can be linked to other organ malformations. In 1996, PHACE syndrome was first defined as the association of large and segmental infantile hemangioma, usually on the face, head, or cervical region, with malformations of the posterior fossa of the brain, arterial anomalies of the central nervous system, coarctation of the aorta, cardiac defects, and ocular abnormalities. Over 300 cases of PHACE syndrome have been reported, and it is cconsidered one of the most common neurocutaneous vascular disorders in childhood. Knowledge of the features and locations of lesions that imply a greater risk of systemic involvement is crucial for the diagnosis and proper management of PHACE syndrome patients. This review highlights the diagnostic criteria for PHACE syndrome, the imaging workup for extracutaneous involvement, the treatment of infantile hemangioma, and the importance of a multidisciplinary approach in the management of these patients.
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Affiliation(s)
- Anita Rotter
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Luciana Paula Samorano
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Maria Cecília Rivitti-Machado
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Zilda Najjar Prado Oliveira
- Dermatology Department, Hospital das Clínicas, Faculdade de
Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Bernardo Gontijo
- Dermatology Unit. Hospital das Clínicas, Universidade
Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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Yao TH, Pataer P, Regmi KP, Gu XW, Li QY, Du JT, Ge SM, Tu JB. Propranolol induces hemangioma endothelial cell apoptosis via a p53‑BAX mediated pathway. Mol Med Rep 2018; 18:684-694. [PMID: 29767244 PMCID: PMC6059697 DOI: 10.3892/mmr.2018.9013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 12/01/2017] [Indexed: 12/11/2022] Open
Abstract
The use of propranolol for the treatment of infantile hemangioma (IH) has been widely investigated in recent years. However, the underlying therapeutic mechanism of propranolol for the treatment of IH remains poorly understood. The aim of the present study was to investigate the expression of proteins regulated by cellular tumor antigen p53 (p53) in associated apoptosis pathways in IH endothelial cells (HemECs) treated with propranolol. Furthermore, the present study aimed to investigate the exact apoptotic pathway underlying the therapeutic effect of propranolol against IH. In the present study, HemECs were subcultured and investigated using an inverted phase contrast microscope, immunocytochemical staining and a scanning electron microscope (SEM). Experimental groups and blank control groups were prepared. All groups were subjected to drug treatment. A high p53 expression model of HemECs was successfully established via transfection, and a low p53 expression model of HemECs was established using pifithrin-α. The apoptosis rate of each group was determined using Annexin V-fluorescein isothiocyanate/propidium iodide double staining and flow cytometry. The expression levels of downstream proteins regulated by p53 [tumour necrosis factor receptor superfamily member 6 (FAS), p53-induced death domain-containing protein (PIDD), death receptor 5 (DR5), BH3-interacting domain death agonist (BID), apoptosis regulator BAX (BAX), p53 unregulated modulator of apoptosis (PUMA), phosphatidylinositol-glycan biosynthesis class S protein (PIGS), and insulin-like growth factor-binding protein 3 (IGF-BP3)] were revealed in the experimental and control groups via western blotting. Microscopic observation revealed the growth of an adherent monolayer of cells, which were closely packed and exhibited contact inhibition. Immunocytochemical staining demonstrated increased expression of clotting factor VIII. SEM analysis revealed presence of Weibel-Palade bodies. The results of the analyses verified that the cultured cells were HemECs. The staining of the samples resulted in a significantly increased rate of apoptosis in experimental groups compared with the blank control group. This result suggested that there is an association between p53 expression and the rate of apoptosis of propranolol-treated HemECs. The results of the western blot analysis demonstrated an upregulation of BAX expression and a downregulation of IGF-BP3 expression in the HemECs treated with propranolol. There were no significant differences in the expression levels of FAS, DR5, PIDD, BID, PUMA and PIGS between experimental and control groups. This result suggests that p53 has an important role in HemEC apoptosis. The results of the present study additionally suggest that the propranolol-induced HemEC apoptosis pathway is a mitochondrial apoptosis pathway and is regulated by p53-BAX signaling.
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Affiliation(s)
- Tian-Hua Yao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Parekejiang Pataer
- Oncology Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R. China
| | - Krishna Prasad Regmi
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Xi-Wen Gu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Quan-Yan Li
- Stomatological Hospital of Tai'an, Tai'an, Shandong 271000, P.R. China
| | - Jing-Ting Du
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Su-Meng Ge
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
| | - Jun-Bo Tu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University Xi'an, Shaanxi 710004, P.R. China
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Ranugha PSS, Betkerur J. Antihypertensives in dermatology Part I - Uses of antihypertensives in dermatology. Indian J Dermatol Venereol Leprol 2018; 84:6-15. [DOI: 10.4103/ijdvl.ijdvl_991_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kaneko T, Sasaki S, Baba N, Koh K, Matsui K, Ohjimi H, Hayashi N, Nakano A, Ohki K, Kuwano Y, Morimoto A, Tamaki Z, Kakazu M, Kishi K, Oyama T, Sato A, Kato R, Higuchi T. Efficacy and safety of oral propranolol for infantile hemangioma in Japan. Pediatr Int 2017; 59:869-877. [PMID: 28453894 DOI: 10.1111/ped.13318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/06/2017] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There have been few reports on the efficacy and safety of oral propranolol at 3 mg/kg/day for infantile hemangioma (IH) in Japanese patients. METHODS A multicenter, open-label phase III study was conducted to evaluate the efficacy and safety of oral propranolol solution in Japanese infants aged 35-150 days with proliferating IH. Thirty-two patients were enrolled in the study, received propranolol solution for 24 weeks at 3 mg/kg/day, and completed the study. RESULTS The success rate (complete or nearly complete resolution) at week 24 (primary endpoint) was 78% (95%CI: 60-91%). The improvement rate since the previous visit was 100% (32/32) after week 5. Overall, the IH surface area, maximum diameter, and color intensity all decreased over time. Consistency in assessment between the centralized and the investigator on-site assessments was observed in 26 patients. Of the 32 patients, 11 needed further treatment other than the study drug. The incidence of adverse events (AE) and drug-related AE was 97% and 31%, respectively. AE that occurred in ≥two patients were either typical of propranolol use (such as blood pressure decrease) or common events in infants. AE that resulted in dose reduction were observed in two patients, but no serious AE or AE that led to study drug discontinuation were observed. CONCLUSION Oral propranolol solution at 3 mg/kg/day is effective and safe in Japanese IH patients.
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Affiliation(s)
- Tsuyoshi Kaneko
- Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Satoru Sasaki
- Center for Vascular Anomalies, KKR Tonan Hospital, Hokkaido, Japan
| | - Naoko Baba
- Department of Dermatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Kiyoshi Matsui
- Department of General Medicine, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Hiroyuki Ohjimi
- Department of Plastic and Reconstructive Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Atsuko Nakano
- Division of Otorhinolaryngology, Chiba Children's Hospital, Chiba, Japan
| | - Kentaro Ohki
- Department of Hematology and Oncology, Gunma Children's Medical Center, Gunma, Japan
| | | | - Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Zenshiro Tamaki
- Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Mariko Kakazu
- Department of Hematology and Oncology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomoki Oyama
- Department of Plastic Surgery, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Atsushi Sato
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
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27
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Abstract
With a prevalence of 4·5%, infantile haemangiomas are the most common benign tumours of infancy, arising in the first few weeks of life and exhibiting a characteristic sequence of growth and spontaneous involution. Most infantile haemangiomas do not require therapy. However, to identify at-risk haemangiomas, close follow-up is crucial in the first weeks of life; 80% of all haemangiomas reach their final size by 3 months of age. The main indications for treatment are life-threatening infantile haemangioma (causing heart failure or respiratory distress), tumours posing functional risks (eg, visual obstruction, amblyopia, or feeding difficulties), ulceration, and severe anatomic distortion, especially on the face. Oral propranolol is now the first-line treatment, which should be administered as early as possible to avoid potential complications. Haemangioma shrinkage is rapidly observed with oral propranolol, but a minimum of 6 months of therapy is recommended.
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Affiliation(s)
| | - John I Harper
- Department of Paediatric Dermatology, Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Peter H Hoeger
- Departments of Paediatrics and Paediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
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28
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Hartmann F, Lockmann A, Grönemeyer LL, Haenssle HA, Zutt M, von Fintel H, Kühnle I, Schön MP, Thoms KM. Nd:YAG and pulsed dye laser therapy in infantile haemangiomas: a retrospective analysis of 271 treated haemangiomas in 149 children. J Eur Acad Dermatol Venereol 2017; 31:1372-1379. [PMID: 27911476 DOI: 10.1111/jdv.14074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/15/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Infantile haemangiomas (IH) are common benign tumours in infancy. Most IH resolve spontaneously, but some require treatment due to ulceration, functional impairment or cosmetic disfiguration. While systemic propranolol is effective in many cases, laser therapy may be a safe topical alternative. OBJECTIVE To assess the efficacy of combined Nd:YAG/pulsed dye laser (PDL) or PDL alone for therapy of IH. PATIENTS AND METHODS A total of 271 IH in 149 infants were treated with combined Nd:YAG/PDL or PDL alone. Based on photographs before and 4-6 weeks after the last treatment, the results were evaluated independently by three physicians. Remissions were categorized as 0-25% (I), 26-50% (II), 51-75% (III) and 76-100% (IV). RESULTS In total, 472 laser treatments were performed. In 137 of 149 infants (91.9%) laser therapy was performed during a short sevoflurane mask anaesthesia, while 12 of 149 infants (8.1%) received topical anaesthetic gel. Combined Nd:YAG/PDL was applied in 187 of 271 IH (69.0%), while PDL alone in 84 of 271 IH (31.0%). On average, 1.74 treatments per IH were necessary (Nd:YAG/PDL: 1.95, PDL: 1.26). Moderate or strong (III/IV) improvement was observed in 92.4% of all IH treated. No serious adverse effects were observed. CONCLUSION Combined Nd:YAG/PDL therapy is an effective and well-tolerated local treatment option for IH of any classification, in any phase of development and at any age. With regard to the systemic use of propranolol, combined Nd:YAG/PDL therapy seems a safe and promising alternative in many cases.
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Affiliation(s)
- F Hartmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - A Lockmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - L-L Grönemeyer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - H A Haenssle
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Zutt
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Department of Dermatology and Allergology, Klinikum Bremen Mitte, Bremen, Germany
| | - H von Fintel
- Department of Pediatrics I, University Medical Center, Göttingen, Germany
| | - I Kühnle
- Department of Pediatrics I, University Medical Center, Göttingen, Germany
| | - M P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - K-M Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
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29
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Abstract
Oral propranolol is now established as the first-line treatment for infantile haemangiomas, and used in up to 20 % of all cases. Propranolol use in infants is most commonly instigated in a controlled environment to monitor for potential serious adverse events such as hypoglycaemia and hypotension. Two test doses are recommended, the first one of 300 μg/kg followed by 2-hourly monitoring. On the subsequent day, a further dose of 650 μg/kg is administered with the same monitoring. A dose of 2 mg/kg divided into three is started from the next day. Parents/carers need to be warned of common adverse effects, of which disturbed sleep is the commonest. Treatment is recommended for up to a year to avoid rebound growth and the need to restart the treatment.
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Affiliation(s)
- Robert H Taylor
- Eye Department, York Hospital, Wigginton Road, York, YO31 8HE, England.
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30
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Shah SD, Baselga E, McCuaig C, Pope E, Coulie J, Boon LM, Garzon MC, Haggstrom AN, Adams D, Drolet BA, Newell BD, Powell J, García-Romero MT, Chute C, Roe E, Siegel DH, Grimes B, Frieden IJ. Rebound Growth of Infantile Hemangiomas After Propranolol Therapy. Pediatrics 2016; 137:peds.2015-1754. [PMID: 26952504 DOI: 10.1542/peds.2015-1754] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES 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.
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Affiliation(s)
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Catherine McCuaig
- Division of Dermatology (Pediatrics), CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Elena Pope
- Department of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Julien Coulie
- Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Laurence M Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires St Luc, Brussels, Belgium
| | - Maria C Garzon
- Departments of Dermatology and Pediatrics, Columbia University, New York, New York
| | - Anita N Haggstrom
- Departments of Dermatology and Pediatrics, Indiana University, School of Medicine, Indianapolis, Indiana
| | - Denise Adams
- Department of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Beth A Drolet
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brandon D Newell
- Division of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri; and
| | - Julie Powell
- Division of Dermatology (Pediatrics), CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | | | - Carol Chute
- Department of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Esther Roe
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Dawn H Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Barbara Grimes
- Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California
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Affiliation(s)
- Anthony J Mancini
- Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, and Departments of Pediatrics and Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Wedgeworth E, Glover M, Irvine A, Neri I, Baselga E, Clayton T, Beattie P, Bjerre J, Burrows N, Foelster-Holst R, Hedelund L, Hernandez-Martin A, Audrain H, Bhate K, Brown S, Baryschpolec S, Darne S, Durack A, Dvorakova V, Gach J, Goldstraw N, Goodyear H, Grabczynska S, Greenblatt D, Halpern J, Hearn R, Hoey S, Hughes B, Jayaraj R, Johansson E, Lam M, Leech S, O'Regan G, Morrison D, Porter W, Ramesh R, Schill T, Shaw L, Taylor A, Taylor R, Thomson J, Tiffin P, Tsakok M, Janmohamed S, Laguda B, McPherson T, Oranje A, Patrizi A, Ravenscroft J, Shahidullah H, Solman L, Svensson A, Wahlgren C, Hoeger P, Flohr C. Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol In the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey. Br J Dermatol 2015; 174:594-601. [DOI: 10.1111/bjd.14233] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 12/25/2022]
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[What's new in paediatric dermatology?]. Ann Dermatol Venereol 2015; 141 Suppl 4:S622-9. [PMID: 25539754 DOI: 10.1016/s0151-9638(14)70166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Regular analysis of the major journals in dermatology and paediatrics has been used to select forty articles which are representative of the past year in paediatric dermatology. This selection is not exhaustive but rather reflects the interests of the author and also the dominant topics in paediatric dermatology in 2013-2014.
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Abstract
A standardized classification system allows improvements in diagnostic accuracy. Multidisciplinary vascular anomaly centers combine medical, surgical, radiologic, and pathologic expertise. This collaborative approach tailors treatment and management of vascular anomalies for affected individuals.
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Affiliation(s)
- Lisa S Foley
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA.
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Treatment of infantile haemangiomas: recommendations of a European expert group. Eur J Pediatr 2015; 174:855-65. [PMID: 26021855 DOI: 10.1007/s00431-015-2570-0] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/12/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED With a prevalence of 2.6-4.5 %, infantile haemangiomas (IH) represent the most common tumour of infancy. While the majority of IH does not require therapy and regresses spontaneously, about 10 % of IH exhibit complications such as obstruction, ulceration or disfigurement. With the advent of oral propranolol, many conventional treatment options have become obsolete. This paper summarizes current recommendations for management of complicated IH. These recommendations have been written by an expert group after a consensus process including bibliographic review, several drafts of synthesis, meetings with quantitative voting system and redaction of an approved final manuscript. CONCLUSION Oral propranolol is the first-line agent for the treatment of complicated IH. WHAT IS KNOWN • Infantile haemangiomas (IH) are the most common tumours of infancy. Within a very short period after its discovery and long before the publication of randomized controlled trials, propranolol has become the number one agent for the treatment of complicated IH. What is New: • We report IH treatment recommendations of an international, interdisciplinary team of experts, based on an up-to-date review of the literature.
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Léauté-Labrèze C. [Propranolol in infantile hemangiomas]. Arch Pediatr 2015; 22:452-5. [PMID: 25753275 DOI: 10.1016/j.arcped.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 01/07/2015] [Indexed: 10/23/2022]
Abstract
Propranolol has been recently approved by health authorities to treat infantile haemangiomas (IH). Propranolol is indicated in infants less than 5months of age with an IH requiring systemic therapy: IH at life-threatening and/or functional risk, painful ulcerated IH and IH that may cause permanent disfigurement. Propranolol should be initiated by physicians who have expertise in the diagnosis, treatment and management of IH. In addition, the first intake and every escalation should be administrated in a controlled clinical setting where adequate facilities for handling of adverse reactions, including those requiring urgent measures, are available. Then a monthly monitoring with dose adjustment weight is mandatory by the family doctor. Parents should be informed of the risk of hypoglycaemia and bronchoconstriction, especially during respiratory infectious outbreaks. The recommended duration of treatment is 6months without tapering. Relapses are possible necessitating a second course of 3 to 6months of treatment.
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Affiliation(s)
- C Léauté-Labrèze
- Unité de dermatologie pédiatrique et centre de référence des maladies rares de la peau, hôpital Pellegrin-Enfants, CHU de Bordeaux, 33076 Bordeaux cedex, France.
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Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, Guibaud L, Baselga E, Posiunas G, Phillips RJ, Caceres H, Lopez Gutierrez JC, Ballona R, Friedlander SF, Powell J, Perek D, Metz B, Barbarot S, Maruani A, Szalai ZZ, Krol A, Boccara O, Foelster-Holst R, Febrer Bosch MI, Su J, Buckova H, Torrelo A, Cambazard F, Grantzow R, Wargon O, Wyrzykowski D, Roessler J, Bernabeu-Wittel J, Valencia AM, Przewratil P, Glick S, Pope E, Birchall N, Benjamin L, Mancini AJ, Vabres P, Souteyrand P, Frieden IJ, Berul CI, Mehta CR, Prey S, Boralevi F, Morgan CC, Heritier S, Delarue A, Voisard JJ. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med 2015; 372:735-46. [PMID: 25693013 DOI: 10.1056/nejmoa1404710] [Citation(s) in RCA: 458] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oral propranolol has been used to treat complicated infantile hemangiomas, although data from randomized, controlled trials to inform its use are limited. METHODS We performed a multicenter, randomized, double-blind, adaptive, phase 2-3 trial assessing the efficacy and safety of a pediatric-specific oral propranolol solution in infants 1 to 5 months of age with proliferating infantile hemangioma requiring systemic therapy. Infants were randomly assigned to receive placebo or one of four propranolol regimens (1 or 3 mg of propranolol base per kilogram of body weight per day for 3 or 6 months). A preplanned interim analysis was conducted to identify the regimen to study for the final efficacy analysis. The primary end point was success (complete or nearly complete resolution of the target hemangioma) or failure of trial treatment at week 24, as assessed by independent, centralized, blinded evaluations of standardized photographs. RESULTS Of 460 infants who underwent randomization, 456 received treatment. On the basis of an interim analysis of the first 188 patients who completed 24 weeks of trial treatment, the regimen of 3 mg of propranolol per kilogram per day for 6 months was selected for the final efficacy analysis. The frequency of successful treatment was higher with this regimen than with placebo (60% vs. 4%, P<0.001). A total of 88% of patients who received the selected propranolol regimen showed improvement by week 5, versus 5% of patients who received placebo. A total of 10% of patients in whom treatment with propranolol was successful required systemic retreatment during follow-up. Known adverse events associated with propranolol (hypoglycemia, hypotension, bradycardia, and bronchospasm) occurred infrequently, with no significant difference in frequency between the placebo group and the groups receiving propranolol. CONCLUSIONS This trial showed that propranolol was effective at a dose of 3 mg per kilogram per day for 6 months in the treatment of infantile hemangioma. (Funded by Pierre Fabre Dermatologie; ClinicalTrials.gov number, NCT01056341.).
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