Delayed-onset of multiple cutaneous infantile hemangiomas due to propranolol: a case report

Benign neonatal hemangiomatosis with early regression of skin lesions: A case report and review of the published work

A 2-day-old Japanese male infant was referred to our outpatient clinic for multiple cutaneous hemangiomas present since birth. Physical examination revealed 14 small, well-circumscribed red papules, scattered over the head, face, dorsum of the right hand, trunk, lower extremities, buttocks and penis. Ultrasound examination revealed no evidence of visceral involvement. Histological examination of a cutaneous lesion was consistent with infantile hemangioma, resulting in the final diagnosis of benign neonatal hemangiomatosis (BNH). The hemangiomas enlarged by 1 month of age and began to resolve at 2 months of age. Within the next month, the lesions had almost completely disappeared. BNH is a rare, non-heritable, self-limited, benign disease characterized by multiple cutaneous infantile hemangiomas and no or unremarkable visceral lesions. Generally, BNH lesions spontaneously regress within the first 1-2 years of life or within 4 months of onset. However, there have been no detailed reports about the time course of BNH. To our knowledge, 31 cases of BNH without hepatic hemangiomas, excluding this case, have been reported so far. Twenty-one of these cases demonstrated spontaneous regression of the cutaneous hemangiomas without treatment. In all cases, the cutaneous hemangiomas were present at birth. The median age at the beginning of spontaneous regression was 6.0 months (range, 1-12) and the median age at complete or almost complete regression was 15 months (range, 3-28). Cutaneous hemangiomas in BNH without hepatic hemangiomas undergo spontaneous regression within the first year of life.

Prolonged growth of infantile hemangioma after pulsed dye laser and oral propranolol treatment

Infantile hemangiomas are the most common tumor of childhood and undergo rapid growth during early infancy followed by gradual involution. After involution, residual lesions sometimes remain. Oral propranolol usually induces earlier involution and redness reduction of infantile hemangiomas. However, the optimal treatment duration is unknown and infantile hemangiomas sometimes recur after cessation of treatment. We report three Japanese patients with recurrent infantile hemangiomas on their cheek. These patients were a 1-month-old female baby with a superficial infantile hemangioma, a 3-month-old female baby with a mixed infantile hemangioma and a 4-month-old male baby with a mixed infantile hemangioma. Two of them also received pulsed dye laser treatment. They did not reach complete or nearly complete resolution of infantile hemangiomas at week 25. These patients experienced regrowth of their infantile hemangioma after 20 months of age and took propranolol after the age of 24 months. There were no severe adverse effects. Propranolol may not only be therapeutic but also prophylactic. Patients with infantile hemangiomas who have taken oral propranolol should be followed up at least 6 months after cessation of treatment, especially infantile hemangiomas on the cheek, and those with partial response to propranolol may require close attention in prolonged growth.

Stress, catecholaminergic system and cancer

Stress as a modern civilization factor significantly affects our lives. While acute stress might have a positive effect on the organism, chronic stress is usually detrimental and might lead to serious health complications. It is known that stress induced by the physical environment (temperature-induced cold stress) can significantly impair the efficacy of cytotoxic chemotherapies and the anti-tumor immune response. On the other hand, epidemiological evidence has shown that patients taking drugs known as β-adrenergic antagonists ("β-blockers"), which are commonly prescribed to treat arrhythmia, hypertension, and anxiety, have significantly lower rates of several cancers. In this review, we summarize the current knowledge about catecholamines as important stress hormones in tumorigenesis and discuss the use of β-blockers as the potential therapeutic agents.