Why Is Infantile Heangiomas Important?
Infantile hemangiomas (IHs), which are characterized by endothelial cell hyperproliferation, are the most common soft tissue tumors of infancy. They occur in 4% to 10% of children younger than one year of age. Females are affected more often than males with ratio of 3:1 [1-2]. Prematurity and low birth weight (<1500 grams) are considered potential predisposing factors. Infantile hemangiomas are characterised by a triphasic clinical and histological evolution with rapid growth (proliferative phase) followed by a plateau period and a slow spontaneous involution (involutive phase) [3-4]. Most hemangiomas become evident within the first few weeks of life and may be subtle at birth, after which they enter a phase of rapid growth lasting from 3 to
6 months [3]. A period of stabilization for a few months follows, with spontaneous involution, which usually takes 3 to 7 years [5]. More than 60% of IH occur on the face, head and neck [6].
Spontaneous regression is expected in majority of hemangiomas, so watchful waiting without any medical intervention is the best management. However medical treatment is needed in approximately 10% to 20% of cases. Presence of serious complications such as obstruction of airway, impairment of vision, gastrointestinal bleeding, ulcerations, infections and hemorrhage necessitate medical treatment. [7-9]. Early recognition and treatment of critical lesions help in preventing or minimising complications. Before 2008, treatment for IH had included systemic and intralesional corticosteroids and α-interferon, which were associated with significant adverse effects [10-11]. In 2008, the first report of the successful use of propranolol radically changed therapy and, since then, propranolol has become the first-line therapeutic agent in the management of IHs [12].
While propranolol’s mechanism of action on IH is still under investigation, it has been shown to induce a better and faster response in IH management than systemic steroids, and is associated with fewer adverse effects [13-14]. In this study we present our successful treatment experience with oral propranolol in patients with hemangioma.
6 months [3]. A period of stabilization for a few months follows, with spontaneous involution, which usually takes 3 to 7 years [5]. More than 60% of IH occur on the face, head and neck [6].
Spontaneous regression is expected in majority of hemangiomas, so watchful waiting without any medical intervention is the best management. However medical treatment is needed in approximately 10% to 20% of cases. Presence of serious complications such as obstruction of airway, impairment of vision, gastrointestinal bleeding, ulcerations, infections and hemorrhage necessitate medical treatment. [7-9]. Early recognition and treatment of critical lesions help in preventing or minimising complications. Before 2008, treatment for IH had included systemic and intralesional corticosteroids and α-interferon, which were associated with significant adverse effects [10-11]. In 2008, the first report of the successful use of propranolol radically changed therapy and, since then, propranolol has become the first-line therapeutic agent in the management of IHs [12].
While propranolol’s mechanism of action on IH is still under investigation, it has been shown to induce a better and faster response in IH management than systemic steroids, and is associated with fewer adverse effects [13-14]. In this study we present our successful treatment experience with oral propranolol in patients with hemangioma.