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LETTER TO EDITOR
Year : 2010  |  Volume : 4  |  Issue : 2  |  Page : 68-69

Propranolol for infantile hemangioma


Department of Pediatric Surgery, BJ Wadia Children Hospital, Parel, Mumbai - 400 012, India

Date of Web Publication24-Mar-2011

Correspondence Address:
Sandeep Hambarde
Departmentof Pediatric Surgery, BJ Wadia Children Hospital, Parel, Mumbai - 400 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.78277

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How to cite this article:
Hambarde S, Bendre P, Nagargoje R, Taide D. Propranolol for infantile hemangioma. Ann Nigerian Med 2010;4:68-9

How to cite this URL:
Hambarde S, Bendre P, Nagargoje R, Taide D. Propranolol for infantile hemangioma. Ann Nigerian Med [serial online] 2010 [cited 2020 Aug 12];4:68-9. Available from: http://www.anmjournal.com/text.asp?2010/4/2/68/78277

Sir,

Infantile hemangiomas (IH) are the most common benign tumors of infancy. [1] Although most IH are innocuous and 85-90% regress spontaneously, some may become life- or function-threatening and require immediate treatment. [1] Previous standard therapeutic options include physical measures (laser surgery, cryosurgery) and systemic corticosteroids, and in severe cases, also requiring vincristine, -interferon or cyclophosphamide, all having the risk of serious side effects. [2],[3] Oral propranolol is a very recent therapeutic option for complicated IH with impressive efficacy and good tolerance. [2]

The effects of propranolol on IH were discovered by chance, and very little is known about its mechanisms of action in IH. [3] The propranolol treatment was discovered by doctors from the Bordeaux Children's Hospital in France, when two infants with hemangiomas were given the drug for cardiac complications while on corticosteroid therapy. The hemangiomas were found to have reduced in size and color.

We treated 20 patients.Within 7 days, all the patients experienced a change in the hemangioma from intense red to purple. This was associated with a palpable softening of the lesion. [1] All the patients selected were below 1 year of age. Informed written consent was taken from all the parents, and permission was obtained from the ethical committee. Routine investigations, baseline blood pressure, electrocardiogram and echocardiogram were done in all the patients. All were followed after 7 days, and thereafter, monthly for 6 months. After the initial color changes, the hemangiomas continued to improve until they were nearly flat, with residual skin telangiectasias. All the patients showed near complete to complete regression of cutaneous and visceral hemangiomas. No patient suffered intra- or post-therapy drug side effects and complications. Propranolol was given as 1 mg/kg/day in two divided doses orally for 6 months. [1]

Propranolol interferes with endothelial cells, vascular tone, angiogenesis and apoptosis. [3],[4] Early, intermediate and long-term effects of propranolol on IH can be attributed to three different pharmacological targets. Early effects (brightening of the hemangioma surface within 1-3 days after the start of therapy) are attributable to vasoconstriction due to decreased release of nitric oxide. [1] Intermediate effects are due to the blocking of proangiogenic signals (vascular endothelial growth factor, basic fibroblast growth factor, matrix metalloproteinase) and result in growth arrest. Long-term effects of propranolol are characterized by induction of apoptosis in proliferating endothelial cells and result in tumor regression. [5],[6],[7]

Propranolol is associated with some side effects, which happen very rarely, like the following:

  • Hypotension
  • Bradycardia
  • Bronchspasm
  • Peripheral vasoconstriction
  • Sleep disturbance
  • Hypoglycemia [6],[7]


None of our patients experienced any of these.

It can be concluded that propranolol given orally for 6 months gives excellent results in IH with no drug-related side effects.

 
   References Top

1.Zimmermann AP, Wiegand S, Werner JA, Eivazi B. Propranolol therapy for infantile haemangiomas: Review of the literature. Int J Pediatr Otorhinolaryngol 2010;74:338-42. Propranolol therapy for infantile haemangioma. J Otolaryngol 2010;2:238-42.   Back to cited text no. 1
    
2.Carlsson IB, Laitinen MP, Scott JE, Louhio H, Velentzis L, Tuuri T, et al. Kit ligand and c-Kit are expressed during early human ovarian follicular development and their interaction is required for the survival of follicles in long-term culture. Reproduction 2006;131:641-9.  Back to cited text no. 2
    
3.García-Cortés M, Lucena MI, Pachkoria K, Borraz Y, Hidalgo R, Andrade RJ. Evaluation of naranjo adverse drug reactions. Aliment Pharmacol Ther 2008;27:780-9.  Back to cited text no. 3
    
4.Hutt KJ, McLaughlin EA, Holland MK. Kit ligand and C-Kit have diverse roles during mammalian oogenesis and folliculogenesis. J Pharmacol Int 2007;45:436-9.  Back to cited text no. 4
    
5.Jephson CG, Manunza F, Syed S, Mills NA, Harper J, Hartley BE. Successful treatment of isolated subglottic haemangioma with propranolol alone. Int J Pediatr Otorhinolaryngol 2009;73:1821-3.  Back to cited text no. 5
    
6.Holmes, Will JM, Mishra A, Gorst C, Liew SH. Propranolol as first-line treatment for infantile hemangiomas. Plast Reconstr Surg2010;125:420-1.  Back to cited text no. 6
    
7.Leaute-Labreze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taieb A. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008;358:2649-51.  Back to cited text no. 7
    




 

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