Beta-blockers in the treatment of hemangiomas in childhood
Authors:
J. Mališ 1; V. Stará 2; S. Klovrzová 4; L. Nováková 1; Š. Čapková 3; K. Švojgr 1; V. Jeřábková 1; S. Cyprová 1; M. Cháňová 1; J. Kozák 5; B. Kocmichová 6; A. Sukop 7; Z. Hříbal 8; R. Pádr 8; K. Bláhová 2; M. Vaculík 5; J. Starý 1
Authors‘ workplace:
Klinika dětské hematologie a onkologie UK 2. LF a FN Motol, Prahapřednosta prof. MUDr. J. Starý, DrSc.
1; Pediatrická klinika UK 2. LF a FN Motol, Prahapřednosta prof. MUDr. J. Lebl, CSc.
2; Poliklinika FN Motol – ambulance dětské dermatologie, Prahaprim. MUDr. Š. Čapková
3; Nemocniční lékárna FN Motol, Prahavedoucí PharmDr. P. Horák
4; Neurochirurgická klinika UK 2. LF a FN Motol, Prahapřednosta doc. MUDr. M. Tichý, CSc.
5; Klinika dětské chirurgie UK 2. LF a FN Motol, Prahapřednosta prof. MUDr. J. Šnajdauf, DrSc.
6; Klinika plastické chirurgie UK 3. LF a FN Královské Vinohrady, Prahapřednosta doc. MUDr. M. Tvrdek
7; Klinika zobrazovacích metod UK 2. LF a FN Motol, Prahapřednosta prof. MUDr. M. Roček, CSc.
8
Published in:
Čes-slov Pediat 2014; 69 (5): 274-282.
Category:
Original Papers
Overview
Introduction:
Infantile hemangiomas (IH) – the most common benign tumors in infants affects 10% to 12% of infants, usually spontaneously involuting, 10–20% progressing IH can cause serious functional problems or cosmetic defect. IH is divided into three groups: superficial 50–60%, subcutaneous (deep) 15%, and mixed 25–35%. The size and number of deposits is highly variable. Leaute-Labréze published (2008) first experience with the use of beta-blocker propranolol as an effective treatment for IH. Propranolol causes vasoconstriction, blocks the effects of the factors supporting the formation of new blood vessels and promotes apoptosis of endothelial cells.
Purpose of the study:
Verification of literary evidence of the effect of propranolol on its own group of children with IH.
Methods, patients and results:
103 children, boys 20 (22%) , girls 83 (78%), med. age 4.6 months. Location of IH: chest 16 (15%), liver 4 (4%) , liver + skin 2 (2%) , limbs 11 (10%), multiple localization 13 (12%), head, face 63 (58%). The target dose of propranolol 2 mg/kg/day, duration of treatment: med. 6.4 months (3 months, 2.5 years), hemangiomas of the liver treated med. 9.7 months. In 9 pts (9%) IH after discontinuation of propranolol therapy should be resumed. Superficial hemangiomas responded best, disappeared without appreciable residue. Deep hemangiomas responded slowly. Mixed hemangiomas leaving residue in 5 cases, must be removed surgically, in 3 cases the residues are treated with laser therapy. Secondary symptoms: 3 low heart rate, 2 hypoglycemia (lowest level 2.8 mmol/l), 1 skin allergic reaction to a syrup, which resolved rapidly after discontinuation. The parents observation – colder acres.
Conclusion:
Generally, this treatment appears to be a simple, efficient and safe, but some complications can be severe – bradycardia, hypoglycemia.
Key words:
hemangioma, infantile hemangioma, beta-blockers, propranolol
Sources
1. Bruckner AL, Frieden IJ. Hemangiomas of infancy. J Am Acad Dermatol 2003; 48: 477–493; quiz 494–476.
2. Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol 2008; 25: 168–173.
3. Haggstrom AN, Drolet BA, Baselga E, et al. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics 2006; 118: 882–887.
4. Mališ J. Hemangiomy kojenců. Česká dermatovenerologie 2014; 4 (1): 7–13.
5. Leaute-Labreze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008; 358: 2649–2651.
6. Hogeling M, Adams S, Wargon O. A randomized controlled trial of propranolol for infantile hemangiomas. Pediatrics 2011; 128: e259–266.
7. Klovrzová S, Zahálka L, Matysová L, Horák P, Sklubalová Z. Pediatrické perorální roztoky s propranolol-hydrochloridem pro magistraliter přípravu: formulace a hodnocení stability. Ceska Slov Farm 2013; 62: 35–39.
8. Chim H, Armijo BS, Miller E, et al. Propranolol induces regression of hemangioma cells through HIF-1alpha-mediated inhibition of VEGF-A. Ann Surg 2012; 256: 146–156.
9. Sans V, de la Roque ED, Berge J, et al. Propranolol for severe infantile hemangiomas: follow-up report. Pediatrics 2009; 124: e423–431.
10. Schiestl C, Neuhaus K, Zoller S, et al. Efficacy and safety of propranolol as first-line treatment for infantile hemangiomas. Eur J Pediatr 2011; 170: 493–501.
11. Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol 2009; 26: 610–614.
12. Holland KE, Frieden IJ, Frommelt PC, et al. Hypoglycemia in children taking propranolol for the treatment of infantile hemangioma. Arch Dermatol 2010; 146: 775–778.
13. Pavlakovic H, Kietz S, Lauerer P, et al. Hyperkalemia complicating propranolol treatment of an infantile hemangioma. Pediatrics 2010; 126: e1589–1593.
14. de Graaf M, Breur JM, Raphael MF, et al. Adverse effects of propranolol when used in the treatment of hemangiomas: a case series of 28 infants. J Am Acad Dermatol 2011; 65: 320–327.
15. Betlloch-Mas I, Martinez-Miravete MT, Lucas-Costa A, et al. J. Outpatient treatment of infantile hemangiomas with propranolol: a prospective study. Actas Dermosifiliogr 2012; 103: 806–815.
16. Drolet BA, Frommelt PC, Chamlin SL, et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics 2013; 131: 128–140.
17. Marqueling AL, Oza V, Frieden IJ, Puttgen KB. Propranolol and infantile hemangiomas four years later: a systematic review. Pediatr Dermatol 2013; 30: 182–191.
18. Čapková Š, Čadová J, Mališ J, Klovrzová S. Terapeutické možnosti u hemangiomů. Dermatol praxi 2013; 7: 109–112.
19. Neri I, Balestri R, Patrizi A. Hemangiomas: new insight and medical treatment. Dermatol Ther 2012; 25: 322–334.
Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2014 Issue 5
Most read in this issue
- Beta-blockers in the treatment of hemangiomas in childhood
- Ethical concerns involving the newborns at risk
- The role of hepcidin in iron metabolism
- Diagnostic methods in intestinal malrotation disorders