Treatment of Infantile Hemangiomas With Beta-Blockers

A Review

Sonal Shah, MD; Ilona J. Frieden, MD

Disclosures

Skin Therapy Letter. 2013;18(6) 

In This Article

Abstract and Introduction

Abstract

Infantile hemangiomas (IH) are the most common tumors occurring in early childhood, with a prevalence of approximately 5–10% of infants. While the natural history of IH is to spontaneously involute, a significant minority of IH require therapy with the aim to prevent disfigurement, functional impairment, or ulceration. In 2008, propranolol, a non-selective beta (β)-blocker, was reported to be highly effective in treating IH. Since that time there have been more than 200 articles published regarding the efficacy and potential toxicity of β-blockers, both systemic and topical, for the treatment of IH. Based on these finding, β-blockers appear to be highly effective in treating IH and are well tolerated, though side effects have been reported. When therapy is appropriately monitored, β-blockers have been proven to be a safer and superior alternative to systemic steroids.

Introduction

Infantile hemangiomas (IH) are the most common tumor occurring in early childhood, with a prevalence of approximately 5–10% of infants.[1] The vast majority of IH undergo rapid proliferation during infancy, particularly in the first weeks to months of life, followed by a slow involution period that lasts several years.[2–4] Because involution occurs spontaneously, most IH do not require treatment. Clinical characteristics including size, location, and subtype (e.g., segmental or very prominent dermal component) can predispose infants to complications including permanent disfigurement, ulceration, and functional impairment, leading to significant morbidity.[5–7] Treatment is indicated to reduce morbidity and prevent or minimize complications.

Until recently, corticosteroids in various forms, including topical, intralesional, or most commonly systemic, were the mainstay in IH treatment; however, response to therapy was varied. In addition, adverse effects with systemic steroids, such as development of Cushingoid features, gastroesophageal reflux, hypertension, growth retardation, and increased susceptibility to infection were major considerations when deciding whether or not to initiate therapy.[5,6,8,9]

In 2008, Labreze et al. reported on the serendipitous observation that propranolol, a non-selective beta (β)-blocker, was efficacious in treating 11 patients with IH.[10] Since that time, there have been more than 200 published articles regarding the use of β-blockers in IH – both systemic and topical, which has revolutionized the therapeutic approach to this common condition.

processing....